Baseline Proms as Predictors of Postoperative Dysphagia Following Cervical Spine Surgery

Introduction: This study investigates the relationship between baseline spine-specific patient-reported outcome measures (PROMs), including Neck Disability Index (NDI), EuroQol 5-Dimension (EQ-5D), EuroQol Visual Analogue Scale (EQ-VAS), and Modified Japanese Orthopedic Association (mJOA) scores, and the incidence of postoperative dysphagia following cervical spine surgery.

Methods: A prospectively collected multi-institutional quality registry was retrospectively reviewed. Patients undergoing cervical surgery were categorized by baseline PROMs using the standardized scoring categories, and correlations with preoperative and postoperative Eating Assessment Tool-10 (EAT-10) dysphagia questionnaire scores were assessed. Including baseline dysphagia as a fixed effect, mixed-effects logistic regressions were performed to examine the impact of patient-reported baseline PROMs on the incidence of dysphagia.

Results: A total of 1,989 NDI, 1,995 EQ-5D, 1,995 EQ-VAS, and 803 mJOA baseline PROMs were collected. Patients in the complete disability (score ≥ 35) and severe disability (25 ≤ score < 35) NDI category had EAT-10 scores significantly above the diagnostic threshold for dysphagia at 1, 3, and 12 months after surgery, while those with no, mild, and moderate disability had average scores significantly below the threshold at 3 and 12 months. When assessing baseline PROMs independently in multivariable analyses, worse baseline NDI (OR=1.03, p< 0.001) and EQ-5D (OR=0.39, p=0.006) scores were significant predictors of dysphagia at 12 months after surgery, while worse EQ-VAS (OR=1.00, p=0.5) and mJOA (OR=0.94, p=0.14) scores were not. When assessing baseline PROMs together in multivariable analysis, worse baseline NDI was a significant predictor of dysphagia at 12 months (OR=1.03, p< 0.001), while EQ-5D (OR=0.65, p=0.3), EQ-VAS (OR=1.00, p=0.2), and mJOA (OR=0.98, p=0.6) were not.

Conclusion : While all four baseline scores are valuable independent predictors of postoperative dysphagia, NDI score appears to be the strongest independent predictor of the four PROMs in determining whether patients have dysphagia at 12 months of cervical surgery.