Date of Award

January 2026

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Ronny Munoz-Acuna

Abstract

Prevalence, Predictors, and Consequences of Postoperative Dysphagia After Aortic SurgeryAndrew Johnson and Ronny Munoz-Acuna, M.D., Department of Anesthesiology, Yale School of Medicine, New Haven, CT 06510. Abstract Background: Postoperative dysphagia is an underrecognized complication following cardiothoracic surgery and is associated with aspiration, prolonged hospitalization, and adverse clinical outcomes. Patients undergoing complex aortic surgery may be at particularly high risk due to prolonged mechanical ventilation, extensive airway instrumentation, and neurologic vulnerability. Data describing the prevalence, predictors, and clinical consequences of postoperative dysphagia in this population remain limited. Research Aim: This study consisted of three aims: first, to determine the prevalence and risk factors associated with postoperative dysphagia among adult patients undergoing total arch or hemiarch aortic repair for both elective and emergent indications; second, to evaluate agreement between bedside and formal swallow assessments; and third, to examine the association of postoperative dysphagia with adverse clinical outcomes, including aspiration pneumonia, reintubation, tracheostomy, feeding tube placement, intensive care unit and hospital length of stay, and mortality. Methods: We conducted a retrospective cohort study of adult patients undergoing total arch or hemiarch aortic repair at a single tertiary care center between 2019 and 2021. Postoperative dysphagia was defined by failure of bedside or formal swallow evaluation, persistent symptoms requiring dietary modification, or need for enteral feeding access. Demographic, clinical, and perioperative variables were compared between patients with and without dysphagia. Multivariable logistic regression with bootstrap resampling was used to identify independent predictors. Agreement between bedside swallow screening and formal instrumental evaluation was assessed. Associations between dysphagia and postoperative outcomes, including aspiration pneumonia, airway interventions, length of stay, and mortality, were examined. Results: Among 125 patients included in the analysis, postoperative dysphagia occurred in 14 patients (11.2%). Patients with dysphagia required significantly longer durations of mechanical ventilation and had markedly prolonged intensive care unit and hospital length of stay compared with those without dysphagia. Dysphagia was strongly associated with aspiration pneumonia, reintubation, tracheostomy, and gastrostomy tube placement. One-year mortality was higher among patients with dysphagia. In multivariable analysis, longer duration of mechanical ventilation was independently associated with postoperative dysphagia. Agreement between bedside swallow screening and formal swallow evaluation was high, with excellent concordance between assessment modalities. Conclusions: Postoperative dysphagia is a common and clinically consequential complication following complex aortic surgery and is strongly associated with prolonged mechanical ventilation and adverse postoperative outcomes. Bedside swallow screening demonstrated excellent agreement with formal instrumental evaluation, supporting its role as an effective early triage tool. These findings underscore the importance of systematic dysphagia screening and targeted postoperative care pathways to reduce aspiration-related morbidity in high-risk aortic surgery populations.

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This is an Open Access Thesis.

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