Dysphagia Incidence after Cardiac Surgery: a Meta-analysis

Background Dysphagia incidence after cardiac surgery is increasing due to increased complexity of the surgery and number of older patients, which has become one of the most severe complications of cardiac surgery, affecting patients' physical health and recovery. Objective To perform a review of available evidence on the incidence of dysphagia after cardiac surgery. Methods Databases of PubMed, Embase, Cochrane Library, CINAHL, Web of Science, CBM, CNKI, Wanfang Data, and VIP were searched from inception to May 2022 for published studies on the incidence of dysphagia after cardiac surgery. Two researchers independently conducted a literature enrollment, quality assessment, and data extraction. Meta-analysis was conducted using Stata 15.0. Results Fifteen studies with 7 880 patients were included. The meta-analysis revealed that the overall incidence of dysphagia after cardiac surgery was 13.3%〔95%CI (10.1%, 16.5%) 〕. Further region-specific analysis indicated that, the incidence of dysphagia following cardiac surgery in Asia, North America, and Oceania was 16.6%〔95%CI (10.4%, 22.8%) 〕, 10.0%〔95%CI (6.1%, 13.8%) 〕, and 17.4%〔95%CI (12.3%, 23.5%) 〕, respectively. According to sex-specific analysis, the incidence of dysphagia following cardiac surgery was 16.9%〔95%CI (11.8%, 21.9%) 〕, and 16.4%〔95%CI (11.1%, 21.8%) 〕 in male and female patients, respectively. The analysis based on age group indicated that the dysphagia incidence following cardiac surgery in patients aged <70 years and ≥70 years was 10.9%〔95%CI (8.6%, 13.5%) 〕 and 28.4%〔95%CI (19.7%, 37.9%) 〕, respectively. And analysis based on NYHA class found that the dysphagia incidence was 11.8%〔95%CI (7.4%, 16.3%) 〕 in patients with NYHA classⅠ or Ⅱ, and was 21.0%〔95%CI (11.0%, 30.9%) 〕 in those with NYHA class Ⅲ or Ⅳ. In accordance with analysis based on the duration of perioperative endotracheal intubation, the incidence of dysphagia following cardiac surgery in patients with <12 hours, 12-24 hours, 25-48 hours and >48 hours was 1.0%〔95%CI (0.3%, 1.8%) 〕, 6.4%〔95%CI (4.4%, 8.3%) 〕, 16.8%〔95%CI (9.5%, 24.1%) 〕, and 55.0%〔95%CI (28.0%, 82.0%) 〕, respectively. In addition, chronic kidney disease, chronic lung disease, previous history of cerebrovascular accident, atrial fibrillation, heart failure, intraoperative transesophageal echocardiography, perioperative stroke and sepsis were associated with a higher incidence of dysphagia after cardiac surgery. The results of the meta-analysis were robust, as shown by sensitivity analysis. Both Begg's and Egger's tests yielded P-value<0.05, indicating that publication bias existed in the studies. Conclusion Current evidence indicates that the incidence of dysphagia after cardiac surgery is high (13.3%), therefore, prompt postsurgical screening and treatment of dysphagia should be administered

Complete blood count reference intervals for healthy Han Chinese adults.

Complete blood count (CBC) reference intervals are important to diagnose diseases, screen blood donors, and assess overall health. However, current reference intervals established by older instruments and technologies and those from American and European populations are not suitable for Chinese samples due to ethnic, dietary, and lifestyle differences. The aim of this multicenter collaborative study was to establish CBC reference intervals for healthy Han Chinese adults.A total of 4,642 healthy individuals (2,136 males and 2,506 females) were recruited from six clinical centers in China (Shenyang, Beijing, Shanghai, Guangzhou, Chengdu, and Xi'an). Blood samples collected in K2EDTA anticoagulant tubes were analyzed. Analysis of variance was performed to determine differences in consensus intervals according to the use of data from the combined sample and selected samples.Median and mean platelet counts from the Chengdu center were significantly lower than those from other centers. Red blood cell count (RBC), hemoglobin (HGB), and hematocrit (HCT) values were higher in males than in females at all ages. Other CBC parameters showed no significant instrument-, region-, age-, or sex-dependent difference. Thalassemia carriers were found to affect the lower or upper limit of different RBC profiles.We were able to establish consensus intervals for CBC parameters in healthy Han Chinese adults. RBC, HGB, and HCT intervals were established for each sex. The reference interval for platelets for the Chengdu center should be established independently

Consensus intervals, validation rates, and comparative interval.

<p>*: Five centers after exclusion of Chengdu,</p><p>^#: only Chengdu center.</p><p>Consensus intervals, validation rates, and comparative interval.</p

Median and mean platelet counts (PLT, A) and eosinophil (EO, B) values for different regions and sexes.

<p>Median and mean platelet counts (PLT, A) and eosinophil (EO, B) values for different regions and sexes.</p

Mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) reference intervals for samples with and without thalassemia trait (TT).

<p>Percentiles for (A) MCV with TT, (B) MCH with TT, (C) MCV without TT, (D) MCH without TT according to regions.</p

Mean platelet count (PLT, A), red blood cell count (RBC, B), mean corpuscular volume (MCV, C), and mean corpuscular hemoglobin (MCH, D) value according to the use of different instruments.

<p>Mean platelet count (PLT, A), red blood cell count (RBC, B), mean corpuscular volume (MCV, C), and mean corpuscular hemoglobin (MCH, D) value according to the use of different instruments.</p

Variations in red blood cell (RBC) profile according to age and sex.

<p>(A) RBC, (B) hemoglobin (HGB), (C) hematocrit (HCT), (D) mean corpuscular volume (MCV), (E) mean corpuscular hemoglobin (MCH), (F) MCH concentration (MCHC). *Females show significantly lower values (<i>P</i> < 0.05) than males in the same age group.</p

Variations in white blood cell (WBC) profile and platelet count (PLT) according to age and sex.

<p>(A) WBC, (B) neutrophils (NEUT), (C) lymphocytes (LYM), (D) monocytes (MONO), (E) eosinophils (EO), (F) PLT. *Females show significantly lower values (<i>P</i> < 0.05) than males in the same age group. △Females show significantly higher values (<i>P</i> < 0.05) than males in the same age group. #EO values are significantly higher (<i>P</i> < 0.05) in the 70–79-year age group than in other age groups in males and females, respectively.</p