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Observational Study
. 2025 Jan:100:111688.
doi: 10.1016/j.jclinane.2024.111688. Epub 2024 Nov 28.

Preoperative dysphagia and adverse postoperative outcomes in middle aged and older adults

Narmeen Abd El Qadir  1 , Harrison N Jones  2 , David A Leiman  3 , Kathryn N Porter Starr  4 , Seth M Cohen  5 ; National COVID Cohort Collaborative (N3C) Consortium
Affiliations
Observational Study

Preoperative dysphagia and adverse postoperative outcomes in middle aged and older adults

Narmeen Abd El Qadir et al. J Clin Anesth. 2025 Jan.

Abstract

Background: Dysphagia is a swallowing impairment with adverse health consequences. The impact of preoperative dysphagia on postoperative outcomes is not known. This study will examine the association between preoperative dysphagia and postoperative outcomes.

Methods: This is a retrospective, observational study of patients ≥50 years of age undergoing surgery not directly involving the swallowing mechanism (i.e., oral cavity, larynx, pharynx, or esophagus). The National COVID Cohort Collaborative (N3C) database from January 1st, 2020 to August 31st, 2023 was used. The N3C database comprises electronic health record (EHR) data from more than 75 US health systems and harmonizes these data in a centralized resource. The main predictor was dysphagia with or without malnutrition in the 3 months prior to surgery. Logistic regression models assessed the association between our main predictor and outcomes of mortality, readmission, and medical/surgical complications adjusted for covariates. A negative binomial regression model was used for length of stay (LOS).

Results: 380,869 adults ≥50 years old were included, mean age 66.0 (SD = 9.2), 52.6 % male. 7.9 % had dysphagia and/or malnutrition 3 months preoperatively including 3.0 % preoperative dysphagia alone, 3.8 % preoperative malnutrition alone, and 1.1 % both. Adjusted models demonstrated higher odds of mortality (1-year mortality odds ratio (OR) 1.37, 95 % confidence interval (CI) 1.29 to 1.44), readmission (90-day readmission OR 1.19, 95 % CI 1.14 to 1.24), and medical/surgical complications (OR 1.35, 95 % CI 1.28 to 1.42) among patients with 3 months preoperative dysphagia with or without malnutrition compared to patients with neither condition.

Conclusion: Patients with 3 months preoperative dysphagia with and without malnutrition had poor postoperative outcomes. These findings highlight the rationale for integrating dysphagia screening and intervention into routine preoperative protocols to mitigate the risk of adverse postoperative outcomes.

Keywords: Dysphagia; Malnutrition; Postoperative outcomes; Preoperative.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Harrison Jones reports a relationship with Sanofi Genzyme that includes: funding grants. Harrison Jones reports a relationship with Aspire Products LLC that includes:. Harrison Jones reports a relationship with Pattern Health that includes: consulting or advisory. Harrison Jones reports a relationship with Amicus Therapeutics that includes: consulting or advisory. Harrison Jones reports a relationship with Northern Speech Services that includes: consulting or advisory. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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