Zhongguo quanke yixue (Jun 2023)
Dysphagia Incidence after Cardiac Surgery: a Meta-analysis
Abstract
Background Dysphagia incidence after cardiac surgery is increasing due to increased complexity of the surgery and number of older patients, which has become one of the most severe complications of cardiac surgery, affecting patients' physical health and recovery. Objective To perform a review of available evidence on the incidence of dysphagia after cardiac surgery. Methods Databases of PubMed, Embase, Cochrane Library, CINAHL, Web of Science, CBM, CNKI, Wanfang Data, and VIP were searched from inception to May 2022 for published studies on the incidence of dysphagia after cardiac surgery. Two researchers independently conducted a literature enrollment, quality assessment, and data extraction. Meta-analysis was conducted using Stata 15.0. Results Fifteen studies with 7 880 patients were included. The meta-analysis revealed that the overall incidence of dysphagia after cardiac surgery was 13.3%〔95%CI (10.1%, 16.5%) 〕. Further region-specific analysis indicated that, the incidence of dysphagia following cardiac surgery in Asia, North America, and Oceania was 16.6%〔95%CI (10.4%, 22.8%) 〕, 10.0%〔95%CI (6.1%, 13.8%) 〕, and 17.4%〔95%CI (12.3%, 23.5%) 〕, respectively. According to sex-specific analysis, the incidence of dysphagia following cardiac surgery was 16.9%〔95%CI (11.8%, 21.9%) 〕, and 16.4%〔95%CI (11.1%, 21.8%) 〕 in male and female patients, respectively. The analysis based on age group indicated that the dysphagia incidence following cardiac surgery in patients aged <70 years and ≥70 years was 10.9%〔95%CI (8.6%, 13.5%) 〕 and 28.4%〔95%CI (19.7%, 37.9%) 〕, respectively. And analysis based on NYHA class found that the dysphagia incidence was 11.8%〔95%CI (7.4%, 16.3%) 〕 in patients with NYHA classⅠ or Ⅱ, and was 21.0%〔95%CI (11.0%, 30.9%) 〕 in those with NYHA class Ⅲ or Ⅳ. In accordance with analysis based on the duration of perioperative endotracheal intubation, the incidence of dysphagia following cardiac surgery in patients with <12 hours, 12-24 hours, 25-48 hours and >48 hours was 1.0%〔95%CI (0.3%, 1.8%) 〕, 6.4%〔95%CI (4.4%, 8.3%) 〕, 16.8%〔95%CI (9.5%, 24.1%) 〕, and 55.0%〔95%CI (28.0%, 82.0%) 〕, respectively. In addition, chronic kidney disease, chronic lung disease, previous history of cerebrovascular accident, atrial fibrillation, heart failure, intraoperative transesophageal echocardiography, perioperative stroke and sepsis were associated with a higher incidence of dysphagia after cardiac surgery. The results of the meta-analysis were robust, as shown by sensitivity analysis. Both Begg's and Egger's tests yielded P-value<0.05, indicating that publication bias existed in the studies. Conclusion Current evidence indicates that the incidence of dysphagia after cardiac surgery is high (13.3%), therefore, prompt postsurgical screening and treatment of dysphagia should be administered.
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