Introduction: Studies have shown that patients undergoing multi-level cervical operations are at greater risk for postoperative dysphagia. This study aims to compare risk factors for postoperative dysphagia in patients undergoing single- and multi-level anterior cervical surgery.
Methods: A quality registry was retrospectively reviewed to identify candidates who underwent single- or multi-level cervical procedures using an anterior approach. Procedures involving two consecutive vertebrae were categorized as single-level, and procedures involving 3+ consecutive vertebrae were categorized as multi-level. Dysphagia rates were determined using Eating Assessment Tool-10 (EAT-10) questionnaire scores. Univariate and multivariate analyses were performed to identify significant risk factors for postoperative dysphagia.
Results: Of 1,704 patients meeting criteria, 803 (47.2%) underwent single-level and 901 (52.8%) underwent multi-level procedures. Both groups had similar rates of baseline dysphagia (14%, p=0.9). Multi-level patients had significantly higher rates of dysphagia at 1 month (64% vs. 53%, p=0.001), 3 months (32% vs. 25%, p=0.004), and 12 months (29% vs. 22%, p=0.005) postoperatively. Multivariable regression revealed that for single-level patients, baseline dysphagia (OR 3.72, p< 0.001), operations involving C3-C4 (OR 2.86, p=0.001), American Society of Anesthesiologists (ASA) grade >1 (OR 2.20, p=0.011), diabetes (OR 2.04, p=0.003), unemployment (OR 1.66, p=0.013), and symptoms for more than 12 months (OR 1.49, p=0.039) were independent predictors of postoperative dysphagia within 12 months of surgery. For multi-level procedures, baseline dysphagia (OR 6.68, p< 0.001), adjacent segment disease (OR 2.24, p=0.024), number of operative levels (OR 1.93, p=0.003), diabetes (OR 1.64, p=0.036), unemployment (OR 1.53, p=0.022), and central stenosis (OR 1.44, p=0.049) were independent predictors of postoperative dysphagia.
Conclusion : Patients undergoing single-level cervical procedures are at lower risk for postoperative dysphagia, but operations involving level C3-C4 and an ASA grade >1 significantly increase this risk, while preoperative dysphagia, diabetes, and unemployment increase risk for both groups. These results can provide insight regarding patient risk for experiencing postoperative dysphagia.
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