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03-04-2013 | Surgery | Article

Postoperative dysphagia concerns for hip fracture surgery


Free abstract

medwireNews: Around a third of elderly patients experience oropharyngeal dysphagia (OD) while recovering from hip fracture surgery, say Australian researchers who have identified markers for the complication.

Overall, 34% of the 181 patients, aged an average of 83 years old, who were assessed at a specialist orthogeriatric unit within 72 hours of surgery showed clinical signs of reduced swallowing efficiency, such as oral residue or multiple swallows per bolus, or had reduced swallowing safety, defined as coughing or choking after swallowing.

Analysis revealed that postoperative OD was significantly more common with increasing age (odds ratio [OR]=1.11), in patients with neurologic or respiratory comorbidity before surgery than those without (OR=3.38 and 2.93, respectively), and patients living in a residential aging care facility (OR=2.58).

In addition, patients who developed postoperative delirium were 2.95 times more likely to experience OD than those who were not confused after their surgery, the team reports in Age and Ageing.

"The development of OD is multifactorial and could be considered part of a geriatric syndrome," write Amanda Love (The Prince Charles Hospital, Brisbane, Queensland) and co-authors.

"Therefore, older and more frail patients such as those among the elderly hip fracture population should be screened routinely for OD post-operatively."

In a forward stepwise multivariate model, the five risk factors allowed identification of patients at risk for postoperative OD with 52% sensitivity, 89% specificity, and positive and negative predictive values of 66.7% and 81.3%, respectively.

"Early identification and management of OD is imperative for the prevention of secondary complications such as aspiration pneumonia, malnutrition and dehydration," emphasize the researchers. They note diagnosis is hampered by the inability to use "gold standard" invasive tests for the complication, such as videofluoroscopy or fiber optic endoscopy.

"Further clinical research is required to determine whether OD post-operatively is a transitory or permanent complication," they add.

By Lynda Williams, Senior medwireNews Reporter

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