Anti-coagulant Drug Usage Correlates with Lower Incidence of Postoperative Dysphagia Following Cervical Surgery

Introduction: Previous studies have indicated decreased esophageal blood flow during cervical surgery as a contributing factor for postoperative dysphagia. However, the effects of anticoagulant drugs, or blood-thinners, on esophageal blood flow during recovery from cervical surgery have yet to be explored. This study examines the relationship between blood-thinner usage and postoperative dysphagia in patients undergoing cervical spine procedures.

Methods: A prospectively collected multi-institutional quality registry was retrospectively reviewed. Patients were categorized based on blood-thinner use and propensity score matched by age, race, gender, and other preoperative characteristics. Dysphagia rates were compared between the groups using Eating Assessment Tool-10 (EAT-10) questionnaire scores. Univariate analyses and relative risk calculations were used to examine the effects of blood-thinners on postoperative dysphagia.

Results: Of 1,661 patients meeting inclusion criteria, 629 (37.9%) reported taking blood-thinners preoperatively. Both cohorts experienced similar rates of preoperative dysphagia (12% vs. 15%, p=0.081). Propensity-score-matching yielded 838 patients with 419 (50%) who used blood-thinners. Patients taking blood-thinners experienced significantly lower rates of postoperative dysphagia at 1 month (50% vs. 62%, p=0.012), 3 months (21% vs. 29%, p=0.007), and 12 months (17% vs. 25%, p=0.009) postoperatively. Patients taking blood-thinners without baseline dysphagia experienced significantly lower rates of new postoperative dysphagia at 1 month (49% vs. 60%, p=0.029), 3 months (18% vs. 28%, p=0.002), and 12 months (15% vs. 24%, p=0.008). Patients taking blood-thinners are at significantly lower risk for experiencing postoperative dysphagia at 1 month (RR: 0.76; 95% CI: 0.62-0.94; p=0.012), 3 months (RR: 0.89; 95% CI: 0.82-0.97; p=0.007), and 12 months (RR: 0.90; 95% CI: 0.83-0.97; p=0.009) following cervical surgery.

Conclusion : Patients taking anti-coagulant drugs experience significantly lower rates of dysphagia after undergoing cervical procedures. This is a novel finding, and while it can inform surgeons on patient risk for experiencing this common postoperative complication, further studies should be done to better understand this correlation.