Oropharyngeal dysphagia and related factors in post-cardiac surgery: a systematic review

Werle, Roberta Weber; Steidl, Eduardo Matias dos Santos; Mancopes, Renata

doi:10.1590/2317-1782/20162015199

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Systematic Review • CoDAS 28 (05) • Sep-Oct 2016 • https://doi.org/10.1590/2317-1782/20162015199 linkcopy

Oropharyngeal dysphagia and related factors in post-cardiac surgery: a systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Purpose To identify the main factors associated with oropharyngeal dysphagia following cardiac surgery through a systematic review of the literature.

Methods A bibliographic search was conducted in the PubMed and ScienceDirect databases using the following keywords: “cardiac surgery”, “deglutition disorders”, and “dysphagia”.

Selection criteria Articles published in Portuguese, English, or Spanish addressing oropharyngeal dysphagia following cardiac surgery were selected with no time limitation. Only studies available in full were included.

Data analysis First, articles were screened for title and abstract. Subsequently, they were submitted to full assessment by two blinded referees. The following data were extracted: authors, year of publication, study design, sample size, variables evaluated, and main results.

Results The main factors related to oropharyngeal dysphagia in post-cardiac surgery were advanced age, presence of comorbidities and other diseases, intubation time, and surgical conditions.

Conclusion The studies showed high heterogeneity, demonstrating that individuals who undergo cardiac surgical procedures, especially the elderly, present several factors related to oropharyngeal dysphagia postoperatively, such as cardiopulmonary bypass, transesophageal echocardiography, associated comorbidities, development of postoperative sepsis, and previous heart conditions.

Keywords:
Heart Diseases; Thoracic Surgery; Deglutition Disorders; Risk Groups; Intensive Care Units

Authors	Study design	Total of sample/ dysphagia patients	Surgical procedures	Variables assessed	Factors related to oropharyngeal dysphagia
Rousou et al.⁽⁹⁾	Retrospective cross-sectional	838/ 23	CABG, coronary bypass and valve repair/replacement	Time of OI, previous S, CPB, left ventricular ejection fraction, time of surgery, type of surgery (with or without CABG).	Time of OI and CPB, reduced left ventricular ejection fraction, time and type of surgery (CABG).
Ferraris et al.⁽¹⁰⁾	Retrospective cross-sectional	1042/ 31	CABG	Age, height, weight, ejection fraction, CPB, DM, creatinine>2.5, increased cholesterol level, presence of COPD, PVD, S, CCF, aspirin therapy preoperatively, preoperative shock, SAH, unstable angina, non-CABG heart surgery, NYHA>2, and reoperations.	Advanced age, DM, hyperdyslipidemia, RI and CCF.
Skoretz et al.⁽¹¹⁾	Retrospective cross-sectional	909 / 51	CABG and valve repair/replacement	Age, comorbidities, time of OI, reintubation, reoperation, atrial fibrillation, readmission in ICU post-extubation, length of stay in ICU, pre- and post-operative hospitalization time and total length of hospitalization.	Advanced age, CCF, atrial fibrillation, previous S, NYHA>2, OI>12 h, reoperation, reintubation, length of stay in ICU, pre- and post-operative hospitalization time, total length of hospitalization and use of TEE.
Hogue et al.⁽¹⁷⁾	Retrospective cross-sectional	869/ 34	CABG, coronary bypass, valve repair/replacement, cardiac tumors, aortic aneurysm repair, and congenital abnormalities identified in adulthood,	Age, history of MI, SAH, DM, S, COPD, RI and OI, left ventricular function, transthoracic echocardiography, time of EC, aortic clamping, low cardiac output after the operation, use of intra-aortic balloon pump, new development of S, RI, hepatic dysfunction, parenteral nutrition, sepsis.	Advanced age, time of OI, use of TEE.
Barker et al.⁽¹⁸⁾	Retrospective cross-sectional	254/ 130	CABG and valve repair/replacement	Age, gender, smoking history, family history of heart disease, surgical risk, DM, NYHA, CCF, SAH, hyperdyslipidemia, previous S, sinus rhythm, COPD, renal risk.	Time of OI, perioperative S and sepsis.

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[1] Caption: S - stroke; CPB - cardiopulmonary bypass; CABG - coronary artery bypass grafting; DM - diabetes mellitus; COPD - chronic obstructive pulmonary disease; PVD - peripheral vascular disease; SAH - systemic arterial hypertension; MI - myocardial infarction; CCF - congestive cardiac failure; OI – orotracheal intubation; RI – renal insufficiency; NYHA – The New York Heart Association functional classification; ICU - intensive care unit; TEE - transesophageal echocardiography