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Year : 2017  |  Volume : 6  |  Issue : 4  |  Page : 24-28

Preoperative predictors of postoperative aspiration risk after cardiac surgery

1 Division of Cardiovascular and Thoracic Surgery, Intermountain Healthcare, Saint George, Utah, USA
2 Department of Rehabilitation and Speech Pathology, Intermountain Healthcare, Saint George, Utah, USA
3 Intermountain Healthcare, Salt Lake City, Utah, USA

Correspondence Address:
Dr. B Jason Bowles
1380 E. Medical Center Drive, Suite 2600, St. George, Utah 84790
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/rcm.rcm_27_17

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Background: Aspiration is a common complication among hospitalized patients, and patients undergoing cardiac surgery are at increased risk. Our aim was to determine if screening for frailty could identify patients at risk for aspiration. Patients and Methods: A prospective cohort study of patients 65 and older undergoing nonemergent heart surgery at a single community hospital for 1 year was performed. All patients were screened for frailty before surgery using the 5-m walk test. All patients were screened for aspiration before and after surgery using 90-mL water swallow challenge protocol. Preoperative risk factors and postoperative outcomes were analyzed. Results: Of 166 patients studied, 16 (9.6%) were considered frail. Eleven patients (6.6%) failed the swallow screen preoperatively, and 34 patients (20.5%) failed postoperatively. Frail patients were 3.4 times more likely to fail the postoperative swallow screen than their nonfrail counterparts (odds ratio [OR] = 3.36; 95% confidence interval [CI]: 1.42–7.96; P = 0.01). After adjusting for age, comorbidities, and surgical factors, the likelihood of aspiration risk was still three times higher in frail patients (OR = 3.01; 95% CI: 1.06–8.98; P = 0.04). Conclusions: Frail patients are at increased risk of aspiration after cardiac surgery, but frailty screening does not identify all patients at risk. The 90-mL water swallow challenge is a simple and inexpensive test that can be used to identify patients at risk for aspiration.

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