Postoperative dysphagia as a predictor of functional decline and prognosis after undergoing cardiovascular surgery

Effects of preoperative beta-hydroxy-beta-methylbutyrate, arginine, and glutamine supplementation on cardiac surgery: A randomized controlled trial

BACKGROUND & AIMS

In older patients undergoing cardiac surgery, physical function is a critical determinant of postoperative outcomes. Beta-hydroxy-beta-methylbutyrate (HMB) supplementation has been shown to promote muscle protein anabolism and inhibit catabolism, thereby preventing muscle weakness. However, its efficacy in older patients undergoing cardiac surgery remains unknown. This study aimed to examine the effects of preoperative HMB supplementation on postoperative physical function and complications in this population.

METHODS

In this single-center, open-label, randomized controlled trial, patients aged ≥65 years scheduled for cardiac surgery were randomized to receive HMB supplementation or no nutritional intervention. The HMB group received HMB 1200 mg, l-glutamine 7000 mg, and l-arginine 7000 mg, once or twice daily, for at least 2 weeks before surgery. Evaluations were performed at baseline and before and after surgery. The primary outcome was the 6-min walking distance (6MWD) before and after surgery. Secondary outcomes included the incidence of complications, muscle mass and strength, physical performance, and length of hospital stay.

RESULTS

Forty-four patients with a mean age of 72.5 years (women, 38 %) were randomized to the HMB (n = 22) or control (n = 22) group. Compared with the control group, the HMB group demonstrated a statistically significant improvement in the 6MWD both at the pre-surgery (448.0 ± 73.5 m vs. 375.5 ± 58.8 m; P = 0.01) and post-surgery time points (428.9 ± 76.4 m vs. 304.5 ± 52.3 m; P = 0.001). Muscle strength and physical performance also showed significant improvements in the HMB group. However, no significant difference in muscle mass was observed between the groups at any time point. The HMB group had a shorter hospital length of stay compared with that of the control group (16.1 ± 3.8 days vs. 20.4 ± 7.6 days, P = 0.03), and no adverse events were observed with the intervention.

CONCLUSIONS

Preoperative HMB supplementation in older adults undergoing cardiac surgery resulted in significant improvements in postoperative exercise capacity and physical function, along with a reduction in the length of hospital stay, without affecting muscle mass.

REGISTRATION NUMBER OF CLINICAL TRIAL

UMIN000030490 (UMINhttps://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000034773).

Impact of Swallowing Assessment Using the Hyodo-Komagane Score on the Severity of Dysphagia and Medical Staff Workload

BACKGROUND

The goal of dysphagia treatment is to ensure a safe and effective reduction in both dysphagia severity and medical staff workload.

OBJECTIVE

To investigate the correlation of the Hyodo-Komagane score with dysphagia severity and medical staff workload.

METHODS

This retrospective cohort study included 96 patients who were referred from other departments for swallowing evaluation from January to April 2021. The correlation between the Hyodo-Komagane score and dysphagia severity was assessed using the Food Intake LEVEL Scale (FILS) score, and its effect on the reduction in medical staff workload was examined using the feeding assistance level of the referred patients.

RESULTS

This study included 96 hospitalised patients, comprising 15 patients with neuromuscular diseases, eight patients with cardiovascular diseases, 12 patients with head and neck diseases (excluding otolaryngological diseases), 34 patients with internal medicine diseases and 27 patients with cerebrovascular diseases, who underwent swallowing evaluation. The FILS score and feeding assistance level significantly improved at discharge compared with that at referral. A significant correlation was observed between the FILS score and feeding assistance level. The Hyodo-Komagane score was correlated with the feeding assistance level at discharge but not at referral.

CONCLUSION

The Hyodo-Komagane score may optimise rehabilitation and reduce dysphagia severity and medical staff workload, indicating its useful effect on dysphagia severity and medical staff labour.

Temporal recovery and prognostic factors for dysphagia following cardiovascular surgery: Retrospective analysis and development of predictive score

OBJECTIVE

Dysphagia is a common complication associated with cardiovascular surgery (CVS). This study sought to better understand recovery timelines, identify risk factors, and create a prognostic model for oral intake restoration.

METHODS

This retrospective study included 134 patients who had CVS between April 2022 and March 2024. We assessed swallowing ability through fiberoptic endoscopic evaluation of swallowing (FEES). We randomly divided the patients' data into a training dataset and a test dataset in a ratio of 70/30 and Kaplan-Meier analyses and Cox regression were used to assess predictors of total oral intake. We also created a scoring system using the estimated regression coefficients.

RESULTS

Most patients with CVS achieved total oral intake in 7-11 days after extubation. Over 168 h of intubation, the presence of penetration or aspiration, a poor FEES score (score > 6), and perioperative complications were significant risk factors for delayed total oral intake. The predicting score was calculated by adding the scores for each individual factor, including FEES score, penetration/aspiration, and preoperative complications. Scores ranged 0-8, categorizing patients into 0-2, 3-5, and 6-8 groups, clearly demonstrating that the higher the predicting score, the longer the time to total oral intake in both the training and the test dataset.

CONCLUSIONS

All risk factors for unsuccessful or delayed total oral intake were intubation for more than a week, poor swallowing ability, and the presence of perioperative complications. The scoring system accurately predicts the restoration of oral intake following CVS.

Impact of maximum phonation time on postoperative dysphagia and prognosis after cardiac surgery

Objective

The incidence of postoperative complications, including dysphagia, increases as the population undergoing cardiovascular surgery ages. This study aimed to explore the potential of maximum phonation time (MPT) as a simple tool for predicting postextubation dysphagia (PED) and major adverse cardiac and cerebrovascular events (MACCEs).

Methods

This retrospective study included 442 patients who underwent elective cardiac surgery at a university hospital. MPT was measured before surgery, and patients were stratified into 2 groups based on normal and abnormal MPTs. Postoperative complications, including PED and MACCEs, were also investigated. Swallowing status was assessed using the Food Intake Level Scale.

Results

MPT predicted PED with prevalence of 11.0% and 18.0% in the normal and abnormal MPT groups, respectively (P = .01). During the follow-up period, MACCEs developed in 17.0% of patients. Frailty, European System for Cardiac Operative Risk Evaluation II score, PED, and MPT were markedly associated with MACCEs (adjusted hazard ratios: 2.25, 1.08, 1.96, and 0.96, respectively). Mediation analysis revealed that MPT positively influenced PED and MACCEs, whereas PED positively influenced MACCEs. The trend in restricted cubic spline analysis indicated that the hazard ratio for MACCEs increased sharply when MPT was <10 seconds.

Conclusions

These findings underscore the potential of MPT as a valuable tool in the preoperative assessment and management of patients undergoing cardiac surgery. By incorporating MPT into routine preoperative evaluations, clinicians can identify patients at a higher risk of PED and MACCEs, allowing for targeted interventions and closer postoperative monitoring. This may improve patient outcomes and reduce the health care costs associated with these complications.

Survival analysis 101: an easy start guide to analysing time-to-event data

Survival analysis, also called time-to-event analysis, is a common approach to handling event data in cardiovascular nursing and health-related research. Survival analysis is used to describe, explain, and/or predict the occurrence and timing of events. There is a specific language used and methods designed to handle the unique nature of event data. In this methods paper, we provide an 'easy start guide' to using survival analysis by (i) providing a step-by-step guide and (ii) applying the steps with example data. Specifically, we analyse cardiovascular event data over 6 months in a sample of patients with heart failure.