Minimum clinically important difference for dysphagia after anterior cervical spine surgery using EAT-10: the peak...

This study aimed to determine minimum clinically important difference (MCID) values for dysphagia using the Eating Assessment Tool-10 (EAT-10) in patients undergoing anterior cervical surgery, focusing on early dissatisfaction and later satisfaction thresholds to guide clinical decisions.

Data were prospectively collected from patients undergoing anterior cervical surgery across three institutions from 2016 to 2024. Dysphagia severity was assessed preoperatively and at various postoperative stages up to 1 year using EAT-10. The inverse probability of treatment weighting was used to control for confounding variables. The retrospective study of patient data employed two analytical phases: the first phase examined the relationship between dissatisfaction at 3 months (indicated by a North American Spine Society satisfaction score > 2) and changes in EAT-10 scores from baseline to peak (i.e., worst) postoperative scores; the second phase focused on recovery, comparing changes in EAT-10 scores from peak postoperative scores to 12 months against satisfaction (score < 2) at 12 months.

The mean ± SD baseline EAT-10 score for the 1463 patients included in the study was 1.5 ± 4.7 and the mean peak score was 5.2 ± 7.4. The patients underwent anterior cervical discectomy and fusion (90%), arthroplasty (6%), or corpectomy (4%); a hybrid procedure was used in 1%. The phase 1 analysis indicated that a 4-point increase in EAT-10 score was a threshold for significant postoperative dissatisfaction in those without baseline dysphagia, with much higher thresholds observed in patients with any baseline dysphagia. In phase 2, among patients with baseline EAT-10 scores < 3 who experienced an increase to EAT-10 score ≥ 8 postoperatively, a subsequent decrease of 9 points by 12 months was necessary to report satisfaction. For patients with baseline scores 3-8 whose postoperative scores rose to ≥ 8, a subsequent decrease of 15 points was necessary for satisfaction. Patients with initial scores of ≥ 8 who did not improve to < 3 immediately after surgery required further reductions of 2-11 points to reach satisfaction.

The MCID thresholds from this study provide crucial benchmarks for assessing dysphagia changes after anterior cervical surgery, allowing tailored interventions. Patients with baseline dysphagia are less likely to experience early dissatisfaction, and high peak scores negatively impact long-term satisfaction. These findings emphasize the importance of proactive dysphagia management to enhance patient outcomes.