xRead - Swallowing Disorders in the Adult Patient (October 2024)

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TABLE I. Demographics of the Prospective OUtcomes in Cricopharyngeus Hypertonicity (POUCH) Database.

TABLE II. Complications Table.

Endo ( N = 237)

Open ( N = 61)

Characteristics

N = 298

Postop Complications

Total

p -Value

Age at surgery, years, mean (SD)

71.8 (11.2)

None

270 (90.6)

220 (92.8)

50 (82.0) 11 (18.0)

p = 0.009

Sex, N (%) Female

Any complication Subcutaneous air

28 (9.4) 11 (3.7)

17 (7.2)

119 (39.9) 179 (60.1)

9 (3.8)

2 (3.3) 3 (4.9)

Male

Leak

4 (1.3)

1 (0.42)

Approach, N (%) Endoscopic

Hematoma

2 (0.67) 1 (0.34) 3 (1.0) 3 (1.0) 2 (0.67)

0 0 0

1

237 (79.5)

Mediastinitis

1 (1.6) 3 (4.9)

Open

61 (20.5) 61 (20.5) 2.5 (1, 11)

RLN injury

Postoperative esophagram, N (%) *

Acute dysphagia

3 (1.3)

0 0

Oropharyngeal

2 (0.84)

Days from surgery, median (IQR)

bruising/laceration

Leak, N (%)

4 (1.3)

Other medical

3 (1.0)

2 (0.84)

1 (1.6)

Residual diverticulum, N (%)

12 (4.0)

RLN = recurrent laryngeal nerve.

* Other results listed in Supplement 1. IQR = interquartile range; SD = standard deviation.

demonstrated one pseudodiverticulum (0.34%), four leaks with contrast in the retropharyngeal soft tissue (0.67%), and twelve residual diverticula (4.0%). Other results are summarized in Supplement 1. A total of 29 postoperative complications were identi fi ed in 28 patients, summarized in Table II. Open proce dures were at higher risk for postoperative complications ( p = 0.009). Subcutaneous air with crepitus was the most common complication ( n = 11, 3.7%). Intraoperative inju ries, such as oropharyngeal bruising or laceration were rare. RLN injury occurred in three patients. Leak occurred in four patients: 1 endoscopic and 3 open. Complication pro fi les between the endoscopic and open approached were somewhat different with leak, hematoma, and media stinitis occurring more in open procedures and dysphagia and oropharyngeal injury occurring during endoscopic pro cedures. Of the endoscopic procedures, 169 used a laser only with 11 complications; 31 used a surgical stapler only with fi ve complications, one used botox only with one com plication; 23 used a combination of laser, stapler, botox, dilation with zero complications, and 11 were unknown with zero complications. Of the open procedures, 35 were stapled with six complications, 12 were hand-sewn with two complications, seven were combined approach (i.e., hand-sewn and stapled) with two complications, and seven were not speci fi ed with one complication. Prior endo scopic repair did not impact complication risk; 10.7% (6/56) of open or endoscopic approaches with a previous endo scopic Zenker repair had a post op complication compared to 9.2% (22/238) complications among those without a pre vious repair ( p = 0.7359; note: four patients had unknown surgical history). Most (81.2%) patients were discharged within 23-h; 8.7% stayed within 48-h, and 10.1% stayed for >48 h. Of the 30 patients categorized as >48-h hospitalization, 15 (50%) had a complication. Only 8 patients had pro longed LOS (>4 days). Patients with complications were signi fi cantly more likely to require prolonged stay >48 h ( p < 0.001). Comparing patients with uncomplicated courses, more patients with open procedures stayed >48 h than those undergoing endoscopic (Table III).

N = 298 Mean age 71.8 (SD 11.2)

Open N = 61 (20.5%)

Endoscopic N = 237 (79.5%)

N E = 17

N O = 11

N O = 50

N

E = 220

With Complications • <23 h, 32.1% • 48 h, 14.2% • >48 h, 57.1% • Full diet, 7.1% • Restricted, 71.4% • Npo/NG tube, 21.4%

No Complications • <23 h, 86.3% • 48 h, 8.1% • >48 h, 5.5% • Full diet, 5.2% • Restricted, 89.3% • Npo/NG tube, 1.1%

Fig. 1. Zenker diverticula treatment algorithm derived from the Pro spective OUtcomes in Cricopharyngeus Hypertonicity (POUCH) database. NG = nasogastric tube; npo = nil-per-os.

Postoperative esophagography was obtained in 61 patient of 278 known data points (22.3%) at a median (IQR) 2.5 1,11 days (Table I). Thirty (49.2%) were in the 23-h observation group, 7 (11.5%) in the 48-h and 24 (39.3%) were >48-h inpatient group. Indi cation for imaging was “ concern for leak ” in 31.1% (19/61) patients and “ surgeon preference ” in the remaining. Results of postoperative imaging

Laryngoscope 134: June 2024

McKeon et al.: Postop Management of ZD, Contemp. Perspective

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