Introduction Patients who have undergone a transhiatal oesophagectomy (THO) are at risk of pharyngeal dysphagia and subsequent aspiration due to potential disruption in deglutitive biomechanics and/or neuropraxic injury to the recurrent laryngeal nerve. An evaluation was conducted of a new multidisciplinary enhanced recovery pathway (ERP) where all patients undergoing oesophagectomy with cervical anastomosis are seen both pre and post operatively by Speech and Language Therapy (SLT).
Method All patients undergoing THO are provided with pre operative counselling and assessment to exclude pre morbid pharyngeal dysphagia. A clinical exam is conducted on day two post surgery and an SLT assisted water soluble swallow (WSS) is conducted on day three, enabling evaluation of deglutitive biomechanics, effectiveness of postural strategies in eliminating aspiration, in conjunction with assessment of anastomic integrity. Data on all patients who underwent THO between February 2014–February 2015 were collected to evaluate SLT intervention, incidence of pharyngeal dysphagia and patient outcomes using the Functional Oral Intake Scale (FOIS).
Results 42 patients underwent THO. No patients had pre-morbid pharyngeal dysphagia. Post operatively 62% (n = 26) of patients presented with pharyngeal dysphagia on radiological examination with reduced hyolaryngeal excursion, reduced epiglottic deflection and opening of the upper oesophageal sphincter. 38.1% (n = 16) patients were identified at bedside assessment as high risk of aspiration and pharyngeal dysphagia was confirmed on WSS. In 100% of these (n = 16) no aspiration occurred when a chin tuck strategy was recommended at onset of WSS. A further 10 patients aspirated on WSS; a chin tuck strategy was recommended and this was effective in eliminating aspiration in 80% (n = 8). All patients were able to commence sips of clear fluid on day three if anastomotic leak was excluded despite pharyngeal dysphagia and aspiration risk with implementation of postural techniques. Overall, 90.5% (n = 38) of patients were tolerating oral intake at time of discharge (FOIS score > 6). Four patients with anastomotic leaks were excluded from outcome measures.
Conclusion Results suggest that involvement of SLT in ERP helps identify patients at risk of aspiration and introduction of strategies e.g. chin tuck can eliminate aspiration which may improve patient care. Further research is indicated to determine the effect of SLT input on patient outcomes.
Disclosure of interest None Declared.