Diabetes as a Significant Risk Factor for Postoperative Dysphagia Following Cervical Spine Surgery

Introduction: This study investigates the relationship between diabetes and the incidence of postoperative dysphagia following cervical surgery.

Methods: A prospectively collected multi-institutional quality registry was retrospectively reviewed. Patients undergoing cervical surgery were categorized by diabetes status, and correlations with preoperative and postoperative Eating Assessment Tool-10 (EAT-10) dysphagia questionnaire scores were assessed. Mixed-effects logistic regressions were performed to examine the impact of preoperative diabetes on postoperative dysphagia.

Results: Of the 2,001 patients meeting inclusion criteria, 400 (20%) had diabetes. Baseline dysphagia rates were not significantly different between groups (14% vs. 18%, p=0.073). Patients with diabetes had a significantly higher incidence of dysphagia at 1 month (66% vs. 54%, p=0.002), 3 months (39% vs. 26%, p< 0.001), and 12 months (33% vs. 24%, p=0.004) after surgery compared to patients without diabetes. Including baseline dysphagia as a fixed effect, multivariable analysis indicated that diabetes was a significant predictor of postoperative dysphagia at 1 month (OR=1.45, p=0.044) and 3 months (OR=1.67, p< 0.001) but not at 12 months (OR=1.24, p=0.2). Patients with diabetes and no baseline dysphagia (329 out of 400, 82.3%) had a significantly higher incidence of new dysphagia at 1 month (62% vs. 50%, p=0.003), 3 months (34% vs. 21%, p< 0.001), and 12 months (27% vs. 18%, p=0.002). The average change in EAT-10 scores between baseline and 12 months was significantly worse in patients with preoperative diabetes (2.429±5.015 vs. 1.698±4.144, p=0.037). Multivariable analysis indicated that diabetes was a significant predictor of new postoperative dysphagia at 1 month (OR=1.47, p=0.049) and 3 months (OR=1.83, p< 0.001) but not at 12 months (OR=1.33, p=0.15).

Conclusion : Diabetes is a significant risk factor for experiencing postoperative dysphagia following cervical surgery. Diabetes correlates with higher incidence of dysphagia at all postoperative time points and is a strong independent predictor of postoperative dysphagia at 1 and 3 months.