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Management of swallowing in supraglottic and extended supraglottic laryngectomy patients
Author(s) -
Wasserman Tamara,
Murry Thomas,
Johnson Jonas T.,
Myers Eugene N.
Publication year - 2001
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/hed.1149
Subject(s) - medicine , swallowing , dysphagia , percutaneous endoscopic gastrostomy , aspiration pneumonia , surgery , rehabilitation , gastrostomy , parenteral nutrition , pneumonia , physical therapy , peg ratio , finance , economics
Background Aspiration of food and liquid following supraglottic and supracricoid laryngectomy has been documented and found to be the most frequent major postoperative complication that extends hospitalization. The advantages as well as disadvantages of discharging a patient with percutaneous endoscopic gastrostomy (PEG) placement and home therapy versus an aggressive in‐hospital dysphagia management program remain controversial. The present investigation examines an aggressive in‐patient postoperative dysphagia management program following decannulation. Methods Twenty‐one patients participated in a four‐part dysphagia management program following decannulation: patient education, indirect therapy, swallowing evaluation, and nutrition education. Results Eleven patients achieved functional swallowing goals prior to discharge with no reports of pneumonia or rehospitalization over a 3‐month follow‐up period. Six patients were discharged with a tracheostomy and duo tube; five of these patients were started on an oral diet the same day of decannulation. Four patients decannulated prior to discharge did not achieve functional swallowing. Conclusion Certain patients can achieve functional swallowing goals prior to discharge and avoid the cost and surgical placement of a PEG. This group required an additional 2 to 3 days of hospitalization; however, the usual and customary charges for aggressive dysphagia management in this group were exceeded by charges for PEG placement and in‐home therapy according to pricing guidelines for the hospital where these patients were treated. Specific patient profiles of those who were unsuccessful relate to extent of surgery, ie, supraglottic + base of tongue (SUPRA + BOT) and supraglottic + vocal fold (SUPRA + VF) resection, and non‐compliance. Complicated patients often require longer rehabilitation and may benefit from a PEG at the time of surgery. © 2001 John Wiley & Sons, Inc. Head Neck 23: 1043–1048, 2001.