| Increased age is an independent risk factor for radiographic aspiration and laryngeal penetration after thoracotomy for pulmonary resection. | |
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MedLine Citation:
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PMID: 20537358 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: Aspiration is an increasingly recognized complication after thoracotomy for pulmonary resection, but mechanisms of postoperative aspiration are poorly characterized. This study sought to evaluate risk factors to better define postthoracotomy aspiration. METHODS: Three hundred twenty-one consecutive patients underwent clinical bedside swallowing evaluations after thoracotomy for pulmonary resection on postoperative day 1. Results of videofluoroscopic swallowing studies were independently reviewed by 2 speech pathologists and were assigned aspiration-penetration scores of either 1 (normal) or greater than 1 (abnormal) based on the worst swallow. Operative, demographic, and outcomes data were abstracted for each patient, and multivariate regression analysis was performed. RESULTS: Seventy-three (22.7%) patients failed bedside evaluation and proceeded to undergo videofluoroscopic swallowing studies. Forty-four (60.3%) patients had an abnormal videofluoroscopic swallowing study result with a mean aspiration-penetration score of 3.9 +/- 0.3. Multivariate analysis showed that older age (68.8 vs 56.2 years, P = .002), prior premature spillage (P = .0006), and vallecular residuals after the swallow (P < .0002) were all associated with aspiration. Interestingly, certain variables were not independently associated with aspiration, including presence of gastroesophageal reflux disease, operative approach or degree of resection, mediastinal lymphadenectomy, preoperative thoracic radiation, same hospitalization reoperation, and pathology. CONCLUSIONS: Postoperative risk of aspiration after thoracotomy for pulmonary resection is characterized by repeatable episodes of oropharyngeal discoordination on videofluoroscopic swallowing studies. We recommend routine videofluoroscopic swallowing studies for all patients older than 67 years before the initiation of oral intake to diminish the incidence of postoperative aspiration. |
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Authors:
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W Brent Keeling; Jonathan M Hernandez; Vicki Lewis; Melissa Czapla; Weiwei Zhu; Joseph R Garrett; K Eric Sommers |
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Publication Detail:
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Type: Journal Article Date: 2010-05-27 |
Journal Detail:
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Title: The Journal of thoracic and cardiovascular surgery Volume: 140 ISSN: 1097-685X ISO Abbreviation: J. Thorac. Cardiovasc. Surg. Publication Date: 2010 Sep |
Date Detail:
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Created Date: 2010-08-20 Completed Date: 2010-09-20 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0376343 Medline TA: J Thorac Cardiovasc Surg Country: United States |
Other Details:
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Languages: eng Pagination: 573-7 Citation Subset: AIM; IM |
Copyright Information:
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2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved. |
Affiliation:
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Division of Cardiothoracic Surgery, Emory University, Atlanta, GA, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Age Factors Aged Deglutition* Deglutition Disorders / etiology*, physiopathology, radiography Female Fluoroscopy Humans Larynx / physiopathology*, radiography Logistic Models Male Middle Aged Pneumonectomy / adverse effects*, methods Pneumonia, Aspiration / etiology*, physiopathology, radiography Point-of-Care Systems Risk Assessment Risk Factors Thoracotomy / adverse effects* Time Factors Video Recording |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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