Predictors of Dysphagia After Anterior Cervical Discectomy and Fusion: A Prospective Multicenter Study

Study design: Multicenter prospective study.

Objective: Our aim was to evaluate the incidence and predictors of postoperative dysphagia in patients undergoing anterior cervical discectomy and fusion (ACDF).

Summary of background data: Dysphagia is a common complication after ACDF that can have significant effect on patients' quality of life, but the frequency of occurrence and potential risk factors are not known.

Methods: A multicenter prospective study was undertaken at three academic sites to evaluate patients undergoing ACDF between September 2018 and September 2020. Included patients were aged 18 to 80 years and were undergoing primary or revision ACDF for a degenerative condition. Dysphagia was assessed using the validated Eating Assessment Tool (EAT-10) questionnaire, with dysphagia defined as EAT-10 ≥ 3.

Results: A total of 170 patients (53.5% female; mean age at surgery 55.0 yr) were included. At preoperative baseline, 23 patients (13.5%) had dysphagia. Rates of dysphagia increased to 45.3% at 2 weeks postoperatively but gradually decreased to 15.3% at 24weeks. On univariate analysis, patients with dysphagia at 2weeks had longer operations (113.1 ± 58.4 vs. 89.0 ± 39.8 minutes, P = 0.003) and higher baseline dysphagia rates (18.2% vs. 6.2%, P = 0.018) and were more likely to be female (66.2% vs. 45.7%, P = 0.009). Patients with prolonged dysphagia had more levels fused (2.1 ± 1.0 vs. 1.7 ± 0.7, P = 0.020), longer operations (131.8 ± 63.1 vs. 89.3 ± 44.3 min-minutes, P < 0.001), and higher baseline dysphagia rates (32% vs. 7.1%, P < 0.001) and were more likely to be smokers (24% vs. 8%, P = 0.021). On multivariate analysis to determine associations with prolonged dysphagia, only smoking status (OR 6.2, 95% CI 1.57-24.5, P = 0.009) and baseline dysphagia (OR 5.1, 95% CI 1.47-17.6, P = 0.01) remained significant.

Conclusion: Dysphagia is common immediately after ACDF, but rates of prolonged dysphagia are similar to preoperative baseline rates. We identified dysphagia rates over time and several patient factors associated with development of short- and long-term postoperative dysphagia.Level of Evidence: 3.