Abstract
BackgroundDysphagia is prevalent in geriatric patients, such as elderly hip fracture patients, and is associated with a poor prognosis. This study investigated (1) the prevalence of dysphagia based on clinical screening and a video-fluoroscopic swallowing study (VFSS), (2) the risk factors of dysphagia, and (3) the prognostic implications of dysphagia in elderly patients (≥ 65 years) undergoing hip fracture surgery.MethodsIn this retrospective study, data from 393 female and 153 male patients ≥65 years of age who underwent surgery for a hip fracture between 2015 and 2018 were analysed. Patients who were considered at high risk of dysphagia after screening underwent a VFSS. To identify risk factors of dysphagia, demographic factors, the American Society of Anesthesiologists classification, past medical history, known risk factors of dysphagia, and factors associated with surgery were analysed using a binary logistic regression model. Odds ratios (ORs) of dysphagia for having poor prognosis including postoperative pneumonia, intensive care unit (ICU) admission, and death within 6 months after surgery were obtained by logistic regression. The association of postoperative pneumonia with poor prognosis was also analysed.ResultsDysphagia was seen in 5.3% of hip fracture patients. In multivariate regression analysis, a serum albumin level < 3.5 g/dL was identified as a risk factor for dysphagia (OR [95%CI] = 3.13 [1.40, 7.01]). Dysphagia was identified as a risk factor for postoperative pneumonia in regression analysis after adjustment (OR [95%CI] = 3.12 [1.05, 9.27]). Postoperative pneumonia was significantly associated with ICU admission (OR [95% CI] = 4.56 [1.85, 11.28]) and death within 6 months after surgery (OR [95% CI] = 2.56 [1.03, 6.33]).ConclusionsDysphagia in elderly hip fracture surgery patients was associated with postoperative pneumonia, a risk factor for poor outcomes including ICU admission and death within 6 months after surgery. A serum albumin level < 3.5 g/dL was identified as a risk factor for dysphagia. Therefore, diagnostic testing should be performed to detect dysphagia, especially in patients with a low serum albumin level. Finally, particular care should be taken to prevent postoperative complications in patients with dysphagia.
Highlights
Dysphagia is prevalent in geriatric patients, such as elderly hip fracture patients, and is associated with a poor prognosis
Among the 546 patients, video-fluoroscopic swallowing study (VFSS) was performed in 40 patients (7.3%) who were considered to be at high risk for dysphagia, and dysphagia was diagnosed in 72.5% (29 of 40) of the patients
Multivariate analysis showed that a serum albumin level < 3.5 g/dL was an independent risk factor for dysphagia (OR = 3.13; 95% Confidence intervals (CI) = 1.40–7.01, P = 0.005) (Table 2)
Summary
Dysphagia is prevalent in geriatric patients, such as elderly hip fracture patients, and is associated with a poor prognosis. Patients with hip fractures are usually those who are frail and often present with an impaired functional status across several health metrics [8, 9]. An acute illness or procedure, including hip fracture surgery, may worsen an already reduced functional reserve and increase patient vulnerability to dysphagia [10]. A previous report identified a high prevalence of dysphagia in hip fracture patients [11]. A negative impact of aspiration pneumonia, which is closely related to dysphagia, on the prognosis of hip fracture patients has been noted [12]. The detection of dysphagia is an important factor in determining the prognosis of elderly patients with hip fracture
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