From the Guidelines
Yes, dysphasia can be a contraindication to surgery in certain circumstances, particularly when severe dysphasia increases the risk of aspiration during and after surgery, leading to serious complications like pneumonia, as noted in the study by R. Burgos et al. 1.
Key Considerations
- Severe dysphasia can impair protective airway reflexes, making general anesthesia risky.
- Elective procedures may be postponed until dysphasia is evaluated and managed.
- Preoperative assessment by a speech-language pathologist and modified anesthesia protocols or postoperative feeding strategies may be necessary.
- In emergency situations, additional precautions such as rapid sequence induction, placement of a nasogastric tube, or consideration of regional anesthesia techniques may be implemented.
Decision Factors
- Severity of dysphasia
- Urgency of the surgery
- Benefits of proceeding versus increased risks of pulmonary complications
Relevant Evidence
The study by R. Burgos et al. 1 highlights the impact of oropharyngeal dysphagia on nutritional intake and the risk of aspiration pneumonia, which is a critical consideration in surgical decision-making. While other studies, such as those referenced by 1, 1, 1, 1, 1, 1, and 1, provide guidance on managing dysphonia and voice outcomes after thyroid surgery, they do not directly address the question of dysphasia as a contraindication to surgery. In contrast, the study by 1 discusses the incidence of dysphagia after laryngectomy and the potential causes of dysphagia following surgery, underscoring the importance of careful evaluation and management of dysphasia in the perioperative period.
From the Research
Dysphasia as a Contraindication to Surgery
- Dysphasia can be a significant consideration in surgical decision-making, as it may impact the patient's ability to recover safely from surgery 2, 3.
- Studies have shown that certain surgical procedures, such as anterior cervical spine surgery, thyroidectomy, and cardiac surgery, can result in postsurgical dysphagia 4, 3, 5, 6.
- The presence of dysphagia can increase the risk of pulmonary complications, such as pneumonia, and may prolong hospitalization 3, 5, 6.
- Certain patient characteristics, such as advanced age, preoperative congestive heart failure, diabetes, and prolonged intubation, may be associated with an increased risk of dysphagia following surgery 5, 6.
- Early identification and assessment of dysphagia are critical to prevent secondary complications and ensure safe and adequate nutritional intake and hydration 4, 5, 6.
Surgical Procedures and Dysphagia
- Anterior cervical spine surgery has been shown to result in dysphagia in a significant proportion of patients, with some studies reporting rates as high as 85% 4.
- Cardiac surgery, particularly in patients with prolonged intubation, can also result in dysphagia, with rates ranging from 13% to 22% 5, 6.
- Other surgical procedures, such as thyroidectomy, laryngeal and pulmonary surgery, esophageal and fundoplication surgery, and gastric and bariatric surgery, may also result in dysphagia 3.
Assessment and Management of Dysphagia
- Clinical and instrumental dysphagia assessment methods, such as flexible endoscopic evaluation of swallowing (FEES) and videofluoroscopic study of swallowing (VFSS), can be used to diagnose and manage dysphagia 4, 6.
- Early involvement of speech-language pathologists and nurses in the care of patients with dysphagia can help prevent secondary complications and ensure safe and adequate nutritional intake and hydration 5, 6.