A Novel Risk Score to Predict Dysphagia After Cardiac Surgery Procedures

Joshua C. Grimm, J. Trent Magruder, Rika Ohkuma, Samuel P. Dungan, Andrea Hayes, Alicia K. Vose, Megan Orlando, Marc S Sussman, Duke E. Cameron, Glenn Whitman

Research output: Contribution to journalArticle

Abstract

Background. Although the exact cause of dysphagia after cardiac operations is unknown, timely diagnosis is critical to avoid a devastating aspiration event. Accordingly, we sought to generate the risk of dysphagia in cardiac surgery (RODICS) score to identify patients at risk for its development after heart surgery. Methods. All adult heart surgery patients at our institution between January 2011 and March 2012 were analyzed. A videofluoroscopic swallow study stratified patients into two groups based on the presence or absence of dysphagia. Covariates (p <0.20) were included in a multivariable model to determine the strongest independent predictors of postoperative dysphagia. Based on the relative odds ratios of significant variables, the RODICS score was generated. Risk cohorts were then created based on easily applicable, whole-integer score cutoffs. Results. During the study period, 115 of 1,314 patients (8.8%) undergoing heart surgery were diagnosed with clinically significant dysphagia. The 38-point RODICS score comprises seven patient-specific characteristics and perioperative factors. The low risk (less than 4), intermediate risk (5 to 9), and high risk (more than 9) cohorts had postoperative dysphagia rates of 3.0%, 6.8%, and 21.6%, respectively (p <0.001). The intermediate-risk cohort (odds ratio 2.3, 95% confidence interval: 1.33 to 4.27, p = 0.01) and high-risk cohort (odds ratio 8.9, 95% confidence interval: 5.22 to 15.32, p <0.001) were at significantly higher risk of dysphagia developing. The RODICS score demonstrated excellent discriminatory ability (area under the curve 0.75). Conclusions. The incidence and impact of dysphagia after open cardiac operations is significant. This novel scoring system could lead to prompt identification of patients at high risk for postoperative dysphagia and potentially minimize the complications of aspiration.

Original languageEnglish (US)
Pages (from-to)568-574
Number of pages7
JournalAnnals of Thoracic Surgery
Volume100
Issue number2
DOIs
StatePublished - Aug 1 2015

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Deglutition Disorders
Thoracic Surgery
Odds Ratio
Confidence Intervals
Deglutition
Area Under Curve

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine
  • Medicine(all)

Cite this

Grimm, J. C., Magruder, J. T., Ohkuma, R., Dungan, S. P., Hayes, A., Vose, A. K., ... Whitman, G. (2015). A Novel Risk Score to Predict Dysphagia After Cardiac Surgery Procedures. Annals of Thoracic Surgery, 100(2), 568-574. https://doi.org/10.1016/j.athoracsur.2015.03.077

A Novel Risk Score to Predict Dysphagia After Cardiac Surgery Procedures. / Grimm, Joshua C.; Magruder, J. Trent; Ohkuma, Rika; Dungan, Samuel P.; Hayes, Andrea; Vose, Alicia K.; Orlando, Megan; Sussman, Marc S; Cameron, Duke E.; Whitman, Glenn.

In: Annals of Thoracic Surgery, Vol. 100, No. 2, 01.08.2015, p. 568-574.

Research output: Contribution to journalArticle

Grimm, JC, Magruder, JT, Ohkuma, R, Dungan, SP, Hayes, A, Vose, AK, Orlando, M, Sussman, MS, Cameron, DE & Whitman, G 2015, 'A Novel Risk Score to Predict Dysphagia After Cardiac Surgery Procedures', Annals of Thoracic Surgery, vol. 100, no. 2, pp. 568-574. https://doi.org/10.1016/j.athoracsur.2015.03.077
Grimm JC, Magruder JT, Ohkuma R, Dungan SP, Hayes A, Vose AK et al. A Novel Risk Score to Predict Dysphagia After Cardiac Surgery Procedures. Annals of Thoracic Surgery. 2015 Aug 1;100(2):568-574. https://doi.org/10.1016/j.athoracsur.2015.03.077
Grimm, Joshua C. ; Magruder, J. Trent ; Ohkuma, Rika ; Dungan, Samuel P. ; Hayes, Andrea ; Vose, Alicia K. ; Orlando, Megan ; Sussman, Marc S ; Cameron, Duke E. ; Whitman, Glenn. / A Novel Risk Score to Predict Dysphagia After Cardiac Surgery Procedures. In: Annals of Thoracic Surgery. 2015 ; Vol. 100, No. 2. pp. 568-574.
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abstract = "Background. Although the exact cause of dysphagia after cardiac operations is unknown, timely diagnosis is critical to avoid a devastating aspiration event. Accordingly, we sought to generate the risk of dysphagia in cardiac surgery (RODICS) score to identify patients at risk for its development after heart surgery. Methods. All adult heart surgery patients at our institution between January 2011 and March 2012 were analyzed. A videofluoroscopic swallow study stratified patients into two groups based on the presence or absence of dysphagia. Covariates (p <0.20) were included in a multivariable model to determine the strongest independent predictors of postoperative dysphagia. Based on the relative odds ratios of significant variables, the RODICS score was generated. Risk cohorts were then created based on easily applicable, whole-integer score cutoffs. Results. During the study period, 115 of 1,314 patients (8.8{\%}) undergoing heart surgery were diagnosed with clinically significant dysphagia. The 38-point RODICS score comprises seven patient-specific characteristics and perioperative factors. The low risk (less than 4), intermediate risk (5 to 9), and high risk (more than 9) cohorts had postoperative dysphagia rates of 3.0{\%}, 6.8{\%}, and 21.6{\%}, respectively (p <0.001). The intermediate-risk cohort (odds ratio 2.3, 95{\%} confidence interval: 1.33 to 4.27, p = 0.01) and high-risk cohort (odds ratio 8.9, 95{\%} confidence interval: 5.22 to 15.32, p <0.001) were at significantly higher risk of dysphagia developing. The RODICS score demonstrated excellent discriminatory ability (area under the curve 0.75). Conclusions. The incidence and impact of dysphagia after open cardiac operations is significant. This novel scoring system could lead to prompt identification of patients at high risk for postoperative dysphagia and potentially minimize the complications of aspiration.",
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T1 - A Novel Risk Score to Predict Dysphagia After Cardiac Surgery Procedures

AU - Grimm, Joshua C.

AU - Magruder, J. Trent

AU - Ohkuma, Rika

AU - Dungan, Samuel P.

AU - Hayes, Andrea

AU - Vose, Alicia K.

AU - Orlando, Megan

AU - Sussman, Marc S

AU - Cameron, Duke E.

AU - Whitman, Glenn

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Y1 - 2015/8/1

N2 - Background. Although the exact cause of dysphagia after cardiac operations is unknown, timely diagnosis is critical to avoid a devastating aspiration event. Accordingly, we sought to generate the risk of dysphagia in cardiac surgery (RODICS) score to identify patients at risk for its development after heart surgery. Methods. All adult heart surgery patients at our institution between January 2011 and March 2012 were analyzed. A videofluoroscopic swallow study stratified patients into two groups based on the presence or absence of dysphagia. Covariates (p <0.20) were included in a multivariable model to determine the strongest independent predictors of postoperative dysphagia. Based on the relative odds ratios of significant variables, the RODICS score was generated. Risk cohorts were then created based on easily applicable, whole-integer score cutoffs. Results. During the study period, 115 of 1,314 patients (8.8%) undergoing heart surgery were diagnosed with clinically significant dysphagia. The 38-point RODICS score comprises seven patient-specific characteristics and perioperative factors. The low risk (less than 4), intermediate risk (5 to 9), and high risk (more than 9) cohorts had postoperative dysphagia rates of 3.0%, 6.8%, and 21.6%, respectively (p <0.001). The intermediate-risk cohort (odds ratio 2.3, 95% confidence interval: 1.33 to 4.27, p = 0.01) and high-risk cohort (odds ratio 8.9, 95% confidence interval: 5.22 to 15.32, p <0.001) were at significantly higher risk of dysphagia developing. The RODICS score demonstrated excellent discriminatory ability (area under the curve 0.75). Conclusions. The incidence and impact of dysphagia after open cardiac operations is significant. This novel scoring system could lead to prompt identification of patients at high risk for postoperative dysphagia and potentially minimize the complications of aspiration.

AB - Background. Although the exact cause of dysphagia after cardiac operations is unknown, timely diagnosis is critical to avoid a devastating aspiration event. Accordingly, we sought to generate the risk of dysphagia in cardiac surgery (RODICS) score to identify patients at risk for its development after heart surgery. Methods. All adult heart surgery patients at our institution between January 2011 and March 2012 were analyzed. A videofluoroscopic swallow study stratified patients into two groups based on the presence or absence of dysphagia. Covariates (p <0.20) were included in a multivariable model to determine the strongest independent predictors of postoperative dysphagia. Based on the relative odds ratios of significant variables, the RODICS score was generated. Risk cohorts were then created based on easily applicable, whole-integer score cutoffs. Results. During the study period, 115 of 1,314 patients (8.8%) undergoing heart surgery were diagnosed with clinically significant dysphagia. The 38-point RODICS score comprises seven patient-specific characteristics and perioperative factors. The low risk (less than 4), intermediate risk (5 to 9), and high risk (more than 9) cohorts had postoperative dysphagia rates of 3.0%, 6.8%, and 21.6%, respectively (p <0.001). The intermediate-risk cohort (odds ratio 2.3, 95% confidence interval: 1.33 to 4.27, p = 0.01) and high-risk cohort (odds ratio 8.9, 95% confidence interval: 5.22 to 15.32, p <0.001) were at significantly higher risk of dysphagia developing. The RODICS score demonstrated excellent discriminatory ability (area under the curve 0.75). Conclusions. The incidence and impact of dysphagia after open cardiac operations is significant. This novel scoring system could lead to prompt identification of patients at high risk for postoperative dysphagia and potentially minimize the complications of aspiration.

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