Perioperative instrumental swallowing evaluation in adult airway reconstruction: A retrospective observational cohort study
Objectives Airway reconstruction for laryngotracheal stenosis (LTS) encompasses several procedures. Dysphagia is a well‐recognised sequela of LTS and airway surgery, however studies have employed mostly non‐validated assessments post‐operatively in small, heterogenous samples, perpetuating uncertain...
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| Veröffentlicht in: | Clinical otolaryngology 2021-11, Vol.46 (6), p.1229-1236 |
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| container_title | Clinical otolaryngology |
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| creator | Haywood, Matthew Lovell, Lindsay Roe, Justin Clunie, Gemma Sandhu, Guri Al Yaghchi, Chadwan |
| description | Objectives
Airway reconstruction for laryngotracheal stenosis (LTS) encompasses several procedures. Dysphagia is a well‐recognised sequela of LTS and airway surgery, however studies have employed mostly non‐validated assessments post‐operatively in small, heterogenous samples, perpetuating uncertainty around the contributions of LTS and its management to impaired deglutition. Consequently, considerable variation in LTS perioperative nutritional management exists. Our objective was to characterise baseline and post‐operative dysphagia with instrumental assessment in an LTS cohort undergoing airway reconstruction and provide a gold‐standard management framework for its management.
Design, setting, participants and main outcome measures
We performed a retrospective cohort study of adult airway reconstruction procedures from 2016‐2020 at our quaternary centre. Patient background, LTS aetiology, procedure type, tube feeding duration, length of stay and serial Functional Oral Intake Scale (FOIS) and International Dysphagia Diet Standardisation Initiative (IDDSI) scores were noted. Baseline, post‐operative day one and post‐stent removal Fibreoptic Endoscopic Evaluation of Swallow (FEES) generated Penetration Aspiration Scale (PAS) scores.
Results
Forty‐four patients underwent forty‐six reconstructions. Baseline incidence of penetration‐aspiration was considerably higher than the general population and worsened in the immediate post‐operative period, however FOIS and PAS scores generally returned to baseline by discharge. Post‐operative FOIS correlated negatively with tracheostomy or airway stent placement. At discharge, 80% tolerated soft or normal diet and 93% were feeding tube independent.
Conclusions
We present the largest adult airway reconstruction cohort with instrumental swallow assessment perioperatively. LTS patients have a higher incidence of underlying dysphagia but swallowing tends to return to baseline with appropriate postoperative rehabilitation. Such practice may avoid the complications, costs and morbidity of prolonged nutritional support. |
| doi_str_mv | 10.1111/coa.13820 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2537632503</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2537632503</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3880-4176de2422e51bc11595a573b0accc1339a776e4b68b441e38b8b8a3e85aac483</originalsourceid><addsrcrecordid>eNp1kU1LAzEQhoMotlYP_gFZ8KKHtskmu8l6K8UvEOpBz8tsOtUt6aYmu12Kf970wx4EM4eEyTMPCS8hl4wOWFhDbWHAuIrpEekyKbK-ECo9Ppyl6pAz7-eUCk4lOyUdLqiSNM665PsVXWmX6KAuVxiVla9ds8CqBhP5FoyxbVl9RLgC0wTEVgGJYNqYOoLStbCOHGq7ndKb67toFDq1s36Jequ0hUe32s4Gp7af1tWRr5vp-pyczMB4vNjvPfL-cP82fuq_TB6fx6OXvuZK0b5gMp1iLOIYE1ZoxpIsgUTygoLWmnGegZQpiiJVhRAMuSpCAUeVAGiheI_c7LxLZ78a9HW-KL1GY6BC2_g8TrhMeZxQHtDrP-jcNi48fEMpRrNUSBao2x2lwz-9w1m-dOUC3DpnNN8kkodE8m0igb3aG5tigdMD-RtBAIY7oC0Nrv835ePJaKf8Ae1cl6A</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2581096471</pqid></control><display><type>article</type><title>Perioperative instrumental swallowing evaluation in adult airway reconstruction: A retrospective observational cohort study</title><source>MEDLINE</source><source>Access via Wiley Online Library</source><creator>Haywood, Matthew ; Lovell, Lindsay ; Roe, Justin ; Clunie, Gemma ; Sandhu, Guri ; Al Yaghchi, Chadwan</creator><creatorcontrib>Haywood, Matthew ; Lovell, Lindsay ; Roe, Justin ; Clunie, Gemma ; Sandhu, Guri ; Al Yaghchi, Chadwan</creatorcontrib><description>Objectives
Airway reconstruction for laryngotracheal stenosis (LTS) encompasses several procedures. Dysphagia is a well‐recognised sequela of LTS and airway surgery, however studies have employed mostly non‐validated assessments post‐operatively in small, heterogenous samples, perpetuating uncertainty around the contributions of LTS and its management to impaired deglutition. Consequently, considerable variation in LTS perioperative nutritional management exists. Our objective was to characterise baseline and post‐operative dysphagia with instrumental assessment in an LTS cohort undergoing airway reconstruction and provide a gold‐standard management framework for its management.
Design, setting, participants and main outcome measures
We performed a retrospective cohort study of adult airway reconstruction procedures from 2016‐2020 at our quaternary centre. Patient background, LTS aetiology, procedure type, tube feeding duration, length of stay and serial Functional Oral Intake Scale (FOIS) and International Dysphagia Diet Standardisation Initiative (IDDSI) scores were noted. Baseline, post‐operative day one and post‐stent removal Fibreoptic Endoscopic Evaluation of Swallow (FEES) generated Penetration Aspiration Scale (PAS) scores.
Results
Forty‐four patients underwent forty‐six reconstructions. Baseline incidence of penetration‐aspiration was considerably higher than the general population and worsened in the immediate post‐operative period, however FOIS and PAS scores generally returned to baseline by discharge. Post‐operative FOIS correlated negatively with tracheostomy or airway stent placement. At discharge, 80% tolerated soft or normal diet and 93% were feeding tube independent.
Conclusions
We present the largest adult airway reconstruction cohort with instrumental swallow assessment perioperatively. LTS patients have a higher incidence of underlying dysphagia but swallowing tends to return to baseline with appropriate postoperative rehabilitation. Such practice may avoid the complications, costs and morbidity of prolonged nutritional support.</description><identifier>ISSN: 1749-4478</identifier><identifier>EISSN: 1749-4486</identifier><identifier>DOI: 10.1111/coa.13820</identifier><identifier>PMID: 34087029</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; airway obstruction ; Cohort analysis ; Cohort Studies ; Complications ; Deglutition Disorders - surgery ; Diet ; Dysphagia ; Emergency ORL ; endoscopy ; Evaluation ; Female ; Humans ; Implants ; Laryngostenosis - surgery ; Larynx ; Male ; Middle Aged ; Morbidity ; Observational studies ; Oesophagus ; Ostomy ; Patients ; Penetration ; Perioperative Period ; Pharynx ; Reconstructive Surgical Procedures - methods ; Rehabilitation ; Respiratory tract ; Retrospective Studies ; speech and language ; Stenosis ; Stents ; subglottic stenosis ; Swallowing ; Trachea ; Tracheal Stenosis - surgery ; Tracheostomy ; Young Adult</subject><ispartof>Clinical otolaryngology, 2021-11, Vol.46 (6), p.1229-1236</ispartof><rights>2021 The Authors. published by John Wiley & Sons Ltd.</rights><rights>2021 The Authors. Clinical Otolaryngology published by John Wiley & Sons Ltd.</rights><rights>2021. This article is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3880-4176de2422e51bc11595a573b0accc1339a776e4b68b441e38b8b8a3e85aac483</citedby><cites>FETCH-LOGICAL-c3880-4176de2422e51bc11595a573b0accc1339a776e4b68b441e38b8b8a3e85aac483</cites><orcidid>0000-0003-3600-7987 ; 0000-0002-5771-5096</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fcoa.13820$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fcoa.13820$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34087029$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Haywood, Matthew</creatorcontrib><creatorcontrib>Lovell, Lindsay</creatorcontrib><creatorcontrib>Roe, Justin</creatorcontrib><creatorcontrib>Clunie, Gemma</creatorcontrib><creatorcontrib>Sandhu, Guri</creatorcontrib><creatorcontrib>Al Yaghchi, Chadwan</creatorcontrib><title>Perioperative instrumental swallowing evaluation in adult airway reconstruction: A retrospective observational cohort study</title><title>Clinical otolaryngology</title><addtitle>Clin Otolaryngol</addtitle><description>Objectives
Airway reconstruction for laryngotracheal stenosis (LTS) encompasses several procedures. Dysphagia is a well‐recognised sequela of LTS and airway surgery, however studies have employed mostly non‐validated assessments post‐operatively in small, heterogenous samples, perpetuating uncertainty around the contributions of LTS and its management to impaired deglutition. Consequently, considerable variation in LTS perioperative nutritional management exists. Our objective was to characterise baseline and post‐operative dysphagia with instrumental assessment in an LTS cohort undergoing airway reconstruction and provide a gold‐standard management framework for its management.
Design, setting, participants and main outcome measures
We performed a retrospective cohort study of adult airway reconstruction procedures from 2016‐2020 at our quaternary centre. Patient background, LTS aetiology, procedure type, tube feeding duration, length of stay and serial Functional Oral Intake Scale (FOIS) and International Dysphagia Diet Standardisation Initiative (IDDSI) scores were noted. Baseline, post‐operative day one and post‐stent removal Fibreoptic Endoscopic Evaluation of Swallow (FEES) generated Penetration Aspiration Scale (PAS) scores.
Results
Forty‐four patients underwent forty‐six reconstructions. Baseline incidence of penetration‐aspiration was considerably higher than the general population and worsened in the immediate post‐operative period, however FOIS and PAS scores generally returned to baseline by discharge. Post‐operative FOIS correlated negatively with tracheostomy or airway stent placement. At discharge, 80% tolerated soft or normal diet and 93% were feeding tube independent.
Conclusions
We present the largest adult airway reconstruction cohort with instrumental swallow assessment perioperatively. LTS patients have a higher incidence of underlying dysphagia but swallowing tends to return to baseline with appropriate postoperative rehabilitation. Such practice may avoid the complications, costs and morbidity of prolonged nutritional support.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>airway obstruction</subject><subject>Cohort analysis</subject><subject>Cohort Studies</subject><subject>Complications</subject><subject>Deglutition Disorders - surgery</subject><subject>Diet</subject><subject>Dysphagia</subject><subject>Emergency ORL</subject><subject>endoscopy</subject><subject>Evaluation</subject><subject>Female</subject><subject>Humans</subject><subject>Implants</subject><subject>Laryngostenosis - surgery</subject><subject>Larynx</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Morbidity</subject><subject>Observational studies</subject><subject>Oesophagus</subject><subject>Ostomy</subject><subject>Patients</subject><subject>Penetration</subject><subject>Perioperative Period</subject><subject>Pharynx</subject><subject>Reconstructive Surgical Procedures - methods</subject><subject>Rehabilitation</subject><subject>Respiratory tract</subject><subject>Retrospective Studies</subject><subject>speech and language</subject><subject>Stenosis</subject><subject>Stents</subject><subject>subglottic stenosis</subject><subject>Swallowing</subject><subject>Trachea</subject><subject>Tracheal Stenosis - surgery</subject><subject>Tracheostomy</subject><subject>Young Adult</subject><issn>1749-4478</issn><issn>1749-4486</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><sourceid>EIF</sourceid><recordid>eNp1kU1LAzEQhoMotlYP_gFZ8KKHtskmu8l6K8UvEOpBz8tsOtUt6aYmu12Kf970wx4EM4eEyTMPCS8hl4wOWFhDbWHAuIrpEekyKbK-ECo9Ppyl6pAz7-eUCk4lOyUdLqiSNM665PsVXWmX6KAuVxiVla9ds8CqBhP5FoyxbVl9RLgC0wTEVgGJYNqYOoLStbCOHGq7ndKb67toFDq1s36Jequ0hUe32s4Gp7af1tWRr5vp-pyczMB4vNjvPfL-cP82fuq_TB6fx6OXvuZK0b5gMp1iLOIYE1ZoxpIsgUTygoLWmnGegZQpiiJVhRAMuSpCAUeVAGiheI_c7LxLZ78a9HW-KL1GY6BC2_g8TrhMeZxQHtDrP-jcNi48fEMpRrNUSBao2x2lwz-9w1m-dOUC3DpnNN8kkodE8m0igb3aG5tigdMD-RtBAIY7oC0Nrv835ePJaKf8Ae1cl6A</recordid><startdate>202111</startdate><enddate>202111</enddate><creator>Haywood, Matthew</creator><creator>Lovell, Lindsay</creator><creator>Roe, Justin</creator><creator>Clunie, Gemma</creator><creator>Sandhu, Guri</creator><creator>Al Yaghchi, Chadwan</creator><general>Wiley Subscription Services, Inc</general><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>M7Z</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-3600-7987</orcidid><orcidid>https://orcid.org/0000-0002-5771-5096</orcidid></search><sort><creationdate>202111</creationdate><title>Perioperative instrumental swallowing evaluation in adult airway reconstruction: A retrospective observational cohort study</title><author>Haywood, Matthew ; Lovell, Lindsay ; Roe, Justin ; Clunie, Gemma ; Sandhu, Guri ; Al Yaghchi, Chadwan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3880-4176de2422e51bc11595a573b0accc1339a776e4b68b441e38b8b8a3e85aac483</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>airway obstruction</topic><topic>Cohort analysis</topic><topic>Cohort Studies</topic><topic>Complications</topic><topic>Deglutition Disorders - surgery</topic><topic>Diet</topic><topic>Dysphagia</topic><topic>Emergency ORL</topic><topic>endoscopy</topic><topic>Evaluation</topic><topic>Female</topic><topic>Humans</topic><topic>Implants</topic><topic>Laryngostenosis - surgery</topic><topic>Larynx</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Morbidity</topic><topic>Observational studies</topic><topic>Oesophagus</topic><topic>Ostomy</topic><topic>Patients</topic><topic>Penetration</topic><topic>Perioperative Period</topic><topic>Pharynx</topic><topic>Reconstructive Surgical Procedures - methods</topic><topic>Rehabilitation</topic><topic>Respiratory tract</topic><topic>Retrospective Studies</topic><topic>speech and language</topic><topic>Stenosis</topic><topic>Stents</topic><topic>subglottic stenosis</topic><topic>Swallowing</topic><topic>Trachea</topic><topic>Tracheal Stenosis - surgery</topic><topic>Tracheostomy</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Haywood, Matthew</creatorcontrib><creatorcontrib>Lovell, Lindsay</creatorcontrib><creatorcontrib>Roe, Justin</creatorcontrib><creatorcontrib>Clunie, Gemma</creatorcontrib><creatorcontrib>Sandhu, Guri</creatorcontrib><creatorcontrib>Al Yaghchi, Chadwan</creatorcontrib><collection>Wiley Online Library (Open Access Collection)</collection><collection>Wiley Online Library (Open Access Collection)</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biochemistry Abstracts 1</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical otolaryngology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Haywood, Matthew</au><au>Lovell, Lindsay</au><au>Roe, Justin</au><au>Clunie, Gemma</au><au>Sandhu, Guri</au><au>Al Yaghchi, Chadwan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Perioperative instrumental swallowing evaluation in adult airway reconstruction: A retrospective observational cohort study</atitle><jtitle>Clinical otolaryngology</jtitle><addtitle>Clin Otolaryngol</addtitle><date>2021-11</date><risdate>2021</risdate><volume>46</volume><issue>6</issue><spage>1229</spage><epage>1236</epage><pages>1229-1236</pages><issn>1749-4478</issn><eissn>1749-4486</eissn><abstract>Objectives
Airway reconstruction for laryngotracheal stenosis (LTS) encompasses several procedures. Dysphagia is a well‐recognised sequela of LTS and airway surgery, however studies have employed mostly non‐validated assessments post‐operatively in small, heterogenous samples, perpetuating uncertainty around the contributions of LTS and its management to impaired deglutition. Consequently, considerable variation in LTS perioperative nutritional management exists. Our objective was to characterise baseline and post‐operative dysphagia with instrumental assessment in an LTS cohort undergoing airway reconstruction and provide a gold‐standard management framework for its management.
Design, setting, participants and main outcome measures
We performed a retrospective cohort study of adult airway reconstruction procedures from 2016‐2020 at our quaternary centre. Patient background, LTS aetiology, procedure type, tube feeding duration, length of stay and serial Functional Oral Intake Scale (FOIS) and International Dysphagia Diet Standardisation Initiative (IDDSI) scores were noted. Baseline, post‐operative day one and post‐stent removal Fibreoptic Endoscopic Evaluation of Swallow (FEES) generated Penetration Aspiration Scale (PAS) scores.
Results
Forty‐four patients underwent forty‐six reconstructions. Baseline incidence of penetration‐aspiration was considerably higher than the general population and worsened in the immediate post‐operative period, however FOIS and PAS scores generally returned to baseline by discharge. Post‐operative FOIS correlated negatively with tracheostomy or airway stent placement. At discharge, 80% tolerated soft or normal diet and 93% were feeding tube independent.
Conclusions
We present the largest adult airway reconstruction cohort with instrumental swallow assessment perioperatively. LTS patients have a higher incidence of underlying dysphagia but swallowing tends to return to baseline with appropriate postoperative rehabilitation. Such practice may avoid the complications, costs and morbidity of prolonged nutritional support.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>34087029</pmid><doi>10.1111/coa.13820</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0003-3600-7987</orcidid><orcidid>https://orcid.org/0000-0002-5771-5096</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Aged, 80 and over airway obstruction Cohort analysis Cohort Studies Complications Deglutition Disorders - surgery Diet Dysphagia Emergency ORL endoscopy Evaluation Female Humans Implants Laryngostenosis - surgery Larynx Male Middle Aged Morbidity Observational studies Oesophagus Ostomy Patients Penetration Perioperative Period Pharynx Reconstructive Surgical Procedures - methods Rehabilitation Respiratory tract Retrospective Studies speech and language Stenosis Stents subglottic stenosis Swallowing Trachea Tracheal Stenosis - surgery Tracheostomy Young Adult |
| title | Perioperative instrumental swallowing evaluation in adult airway reconstruction: A retrospective observational cohort study |
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