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The effect of underlying diseases on pneumonia risk in patients with neurogenic or tumor-related dysphagia: a retrospective cohort study

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Title: The effect of underlying diseases on pneumonia risk in patients with neurogenic or tumor-related dysphagia: a retrospective cohort study
Authors: Almut C. Niessen, Jana Zang, Ferkhunda Tinat, Julie C. Nienstedt, Frank Müller, Till Flügel, Julia Glinzer, Christina Pflug
Source: Eur Arch Otorhinolaryngol
Publisher Information: Springer Science and Business Media LLC, 2024.
Publication Year: 2024
Subject Terms: Male, Adult, Aged, 80 and over, Middle Aged, Pneumonia, Aspiration, Head and Neck Neoplasms/complications [MeSH], Neurogenic dysphagia, Female [MeSH], Aged, 80 and over [MeSH], Pneumonia, Aspiration/etiology [MeSH], Aged [MeSH], Adult [MeSH], Humans [MeSH], Nervous System Diseases/complications [MeSH], Severity of Illness Index [MeSH], Nervous System Diseases/epidemiology [MeSH], Pneumonia risk, Retrospective Studies [MeSH], Middle Aged [MeSH], Risk Factors [MeSH], Food adaptation, Miscellaneous, Nervous System Diseases/etiology [MeSH], Male [MeSH], Pneumonia, Aspiration/epidemiology [MeSH], Dysphagia in head and neck cancer, Deglutition Disorders/epidemiology [MeSH], Deglutition Disorders/etiology [MeSH], Severity of Illness Index, 03 medical and health sciences, 0302 clinical medicine, Head and Neck Neoplasms, Risk Factors, Humans, Female, Nervous System Diseases, Deglutition Disorders, Retrospective Studies, Aged
Description: Objective To analyze the association of neurological disorders (ND) and head and neck cancer (HNC) with dysphagia severity and aspiration pneumonia occurrence. Method Retrospective cohort study conducted at a university dysphagia center) for two consecutive years. Patients with ND or HNC were included if they had undergone a flexible endoscopic swallowing evaluation (FEES) at the dysphagia center, and at least one food consistency had been sampled and recorded. Outcomes of interest were swallowing safety, highest penetration-aspiration-score (PASmax), way of food intake, presence of a tracheal tube, and occurrence of pneumonia within the past two years. Results Of 257 consecutive patients, 199 were enrolled in the study and classified according to their underlying diagnosis into ND (120 patients) or HNC (79 patients). Forty-three HNC patients (54.4%) and 54 ND patients (45%) showed critical dysphagia in FEES (PAS ≥ 6). Binary logistic regression comparing both groups showed patients with ND to be 2.31 times more likely to develop pneumonia. However, if the 32 stroke patients were excluded from the calculation, PASmax remains the only significant variable affecting pneumonia risk in both groups. Liquids were the main challenge for ND patients, while aspirating HNC patients struggled with all consistencies. Conclusions The study shows that patients with HNC and ND differ in pneumonia risk only if stroke patients are included in the ND group. If they are excluded, the PAS score is the only remaining risk factor for pneumonia. Thickening liquids may not be suitable for all dysphagic patients; individually tailored measures might be more helpful, especially for HNC patients.
Document Type: Article
Other literature type
Language: English
ISSN: 1434-4726
0937-4477
DOI: 10.1007/s00405-024-08815-6
Access URL: https://pubmed.ncbi.nlm.nih.gov/38992194
https://repository.publisso.de/resource/frl:6520003
Rights: CC BY
Accession Number: edsair.doi.dedup.....f1cd45c8353aa02795cc95ea10c9c73a
Database: OpenAIRE
Description
Abstract:Objective To analyze the association of neurological disorders (ND) and head and neck cancer (HNC) with dysphagia severity and aspiration pneumonia occurrence. Method Retrospective cohort study conducted at a university dysphagia center) for two consecutive years. Patients with ND or HNC were included if they had undergone a flexible endoscopic swallowing evaluation (FEES) at the dysphagia center, and at least one food consistency had been sampled and recorded. Outcomes of interest were swallowing safety, highest penetration-aspiration-score (PASmax), way of food intake, presence of a tracheal tube, and occurrence of pneumonia within the past two years. Results Of 257 consecutive patients, 199 were enrolled in the study and classified according to their underlying diagnosis into ND (120 patients) or HNC (79 patients). Forty-three HNC patients (54.4%) and 54 ND patients (45%) showed critical dysphagia in FEES (PAS ≥ 6). Binary logistic regression comparing both groups showed patients with ND to be 2.31 times more likely to develop pneumonia. However, if the 32 stroke patients were excluded from the calculation, PASmax remains the only significant variable affecting pneumonia risk in both groups. Liquids were the main challenge for ND patients, while aspirating HNC patients struggled with all consistencies. Conclusions The study shows that patients with HNC and ND differ in pneumonia risk only if stroke patients are included in the ND group. If they are excluded, the PAS score is the only remaining risk factor for pneumonia. Thickening liquids may not be suitable for all dysphagic patients; individually tailored measures might be more helpful, especially for HNC patients.
ISSN:14344726
09374477
DOI:10.1007/s00405-024-08815-6