• Emily K Plowman, Amber Anderson, Justine Dallal York, Lauren DiBiase, Terrie Vasilopoulos, George Arnaoutakis, Thomas Beaver, Tomas Martin, and Eric I Jeng.
• Aerodigestive Research Core, University of Florida, Gainesville, Fla; Department of Speech, Language and Hearing Sciences, University of Florida, Gainesville, Fla; Division of Cardiothoracic Surgery, Department of Surgery, University of Florida, Gainesville, Fla. Electronic address: eplowman@phhp.ufl.edu.
• J. Thorac. Cardiovasc. Surg. 2023 Feb 1; 165 (2): 737746.e3737-746.e3.

ObjectivesThe study objectives were to determine the prevalence of swallowing impairment in adults after cardiac surgery and examine associated risk factors and health-related outcomes.MethodsA prospective single-center study was conducted in postoperative adult cardiac surgery patients with no history of dysphagia. A standardized fiberoptic endoscopic evaluation of swallowing was performed within 72 hours of extubation. Blinded raters completed validated outcomes of swallowing safety and efficiency. Demographic, surgical, and postoperative health-related outcomes were collected. Univariate and multivariable regression analyses were performed with odds ratios (OR) and 95% confidence intervals (CIs).ResultsIn 182 patients examined, imaging confirmed inefficient swallowing (residue) in 52% of patients and unsafe swallowing in 94% (65% penetrators, 29% aspirators). Silent aspiration was observed in 53% of aspirators, and 32% did not clear aspirate material. Independent risk factors for aspiration included New York Heart Association III and IV (OR, 2.9; CI, 1.2-7.0); reoperation (OR, 2.0; CI, 0.7-5.5); transesophageal echocardiogram images greater than 110 (OR, 2.6; CI, 1.1-6.3); intubation greater than 27 hours (OR, 2.1; CI, 0.8-5.3); and endotracheal tube size 8.0 or greater (OR, 3.1; CI, 1.1-8.6). Patients with 3 or 4 identified risk factors had a 16.4 (CI, 3.2-148.4) and 22.4 (CI, 3.7-244.7) increased odds of aspiration, respectively. Compared with nonaspirators, aspirators waited an additional 85 hours to resume oral intake, incurred $49,372 increased costs, and experienced a 43% longer hospital stay (P < .05). Aspiration was associated with pneumonia (OR, 2.6; CI, 1.1-6.5), reintubation (OR, 5.7; CI, 2.1-14.0), and death (OR, 2.8; CI, 1.2-9.0).ConclusionsTracheal aspiration was prevalent, covert, and associated with increased morbidity and mortality.Published by Elsevier Inc.

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