The impact of pre-operative Speech Pathology assessment and intervention on swallowing and health outcomes following a 3-stage oesophagectomy: a before and after study

Ms Amelia Starkey1, Miss Laura Lincoln1

1St Vincent’s Public Hospital, Sydney, Australia

Oesophagectomy is an aggressive surgical approach to manage oesophageal cancer. Complications post oesophagectomy, such as aspiration pneumonia and oropharyngeal dysphagia, impact on post-operative outcomes. In 2019, a pre-oesophagectomy speech pathology clinical pathway was introduced at St Vincent’s Hospital, Sydney to address this practice gap. This study aimed to evaluate whether the introduction of pre-operative speech pathology assessment and intervention had an impact on post-operative swallowing function and health outcomes for 3-stage oesophagectomy patients. Before and after study design. Medical records were audited retrospectively for two patient groups who underwent a 3-stage oesophagectomy (2015-2021); 1) received usual care 2) received pre-operative Speech Pathology assessment and ongoing intervention (intervention). Data was exported into SPSS for analysis using descriptive and inferential statistics (Mann Whitney U Test, chi squares) with outcomes between groups compared. Preliminary analysis suggests there isn’t a statistically significant difference between groups in relation to incidence of penetration/aspiration on the leak test ((Χ2(1)= 1.292, p = 0.45), time from surgery to commencing oral intake (U=57.5, z=-1.42, p=0.17) or length of admission (U=89.5, z=-0.39, p=0.70). However, the data does suggest oral intake was more likely to be modified in the intervention group, thereby reducing the risk of aspiration. Additionally, documented evidence in improvement in multidisciplinary (MDT) communication has increased (100% intervention; 20% usual care). Final results of audits (2015-2021) and associated outcomes will be presented as well as implications for clinical practice. Preliminary results indicate early speech pathology intervention may not have a significant impact on functional outcomes, however, improvement in MDT communication and proactively reducing risk of aspiration have the potential to optimise provision of care for this unique cohort of patients.


Biography:

Laura graduated with her Speech Pathology degree from the University of Sydney in 2014 where she has since had the pleasure of working in acute tertiary hospitals in varying capacities. She has worked across a plethora of clinical areas including neurology, critical care, oncology, surgical and head and neck cancer, finishing her laryngectomy and tracheostomy competencies in 2018. She worked closely with the multidisciplinary head and neck cancer team to provide evidence based patient centred care to both local and rural patients across the state. This included providing on call support to clinicians working solo in these remote centres. This experience sparked an interest for Laura working with surgical teams to provide holistic care to patients where the focus on treatment predominately surgical.

Amelia has been an acute care speech pathologist for over 10 years primarily working in aged care, stroke, gastroenterology and upper GI surgery. She has a keen interest in improving the efficiency of service delivery and has experience as discipline manager coinciding with the global pandemic, requiring dynamic shifts to service provision in response to the hospital pandemic plan. Her current research was born out of a need to improve the service delivery model for patients who have undergone a 3 stage oesophagectomy.

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