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| Age is an Independent Risk Factor for Aspiration Following Thoracotomy for Pulmonary Resection | |||||||||||||||||||||||||||||||||
William B. Keeling1, Jonathan M. Hernandez2, Vicki Lewis3, Melissa Czapla3, Weiwei Zhu3, Joseph Garrett2, Eric Sommers2; 1Emory University, Atlanta, GA; 2University Of South Florida, Tampa, FL; 3H. Lee Moffitt Cancer Center, Tampa, FL
Methods: 321 consecutive patients underwent clinical bedside swallowing evaluations following thoracotomy for pulmonary resection on postoperative day one. Videofluoroscopic swallowing studies (VFSS) were independently reviewed by two speech pathologists and were assigned Aspiration-Penetration (AS-PEN) scores of either 1 (normal) or >1 (abnormal). Operative, demographic and outcomes data were abstracted for each patient and multivariate regression analysis was performed. Results: 73 (22.7%) patients failed bedside evaluation and proceeded to undergo VFSS. Forty-four (60.3%) patients had an abnormal VFSS with a mean AS-PEN score of 3.89 ± .29. Univariate analysis of data comparing patients with normal versus abnormal AS-PEN scores are displayed in table 1. Multivariate analysis showed that older age (69.2 versus 53.0) (p=.002), prior or current head and neck cancer (p<.0021) premature spillage (p=.0006), and vallecular residuals (p<.0002) were all associated with aspiration. Interestingly, certain variables were not independently associated with aspiration including presence of gastroesophegeal reflux disease, operative approach or degree of resection, mediastinal lymphadenectomy, preoperative radiation, same hospitalization re-operation, and pathology. Conclusion: Postoperative risk of aspiration following thoracotomy for pulmonary resection is characterized by repeatable episodes of pharyngeal dyscoordination on VFSS. We recommend routine VFSS for all patients older than 65 and those with prior or current head and neck cancer before the initiation of oral intake in order to diminish the incidence of postoperative aspiration. Results of Univariate Analysis
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