S3271 Impacts of Dysphagia Among Stroke Patients, Retrospective Nationwide Cohort Study

Abstract

Introduction: Oropharyngeal dysphagia is frequent in hospitalized post-stroke patients; some studies suggest its presence in 37% to 78% of stroke survivors and are associated with increased catastrophic consequences related to this dysphagia, including; pneumonia, malnutrition, and longer hospitalization period. Methods: A retrospective analysis utilizing the de-identified data from the National Inpatient Sample (NIS) was used to analyze patients hospitalized with acute stroke as a primary admission diagnosis from 2004 through 2014. Hospital encounters for dysphagia were identified using the International Classification of Diseases (ICD-9) diagnostic codes'7872'. The NIS is a component of the Healthcare Cost and Utilization Project, a national health care database developed through a partnership among federal and state governments and health care institutions sponsored by the Agency for Healthcare Research and Quality. We extracted baseline medical and demographic data, including age, pneumonia, malnutrition, length of stay, and total charges. Categorical variables were compared using the chi-square test, and continuous variables were compared using the t-test. P-values less than 0.05 indicated a statistically significant association. The odds ratio and 95% confidence interval were also calculated. Data analysis was done using STATA Statistical Software, Release 16 (College Station, TX: StataCorp LLC.) Results: A total of 1979090 admissions for acute stroke were identified, of which 128065 patients with dysphagia. The average age is older for acute stroke patients with dysphagia (SWD) (75.81 vs 71.40; P < 0.001). Medical events were higher in SWD patients, including; pneumonia (7.7% vs 6.8%; P < 0.001), malnutrition (1.9% vs 0.7%; P < 0.001), sepsis (5.1% vs 3.7%; P < 0.001), dehydration (9.9% vs 7.4%; P < 0.001), acute kidney injury (10.3% vs 9.3%; P < 0.001), and atrial fibrillation (28.0 % vs 21.4%; P < 0.001). Length of stay is longer for SWD (9 vs 5.53 days; P < 0.001), and the total charges were significantly higher as well (55894.51 vs 38454.54 U.S. dollar; P < 0.001). Conclusion: Guidelines advocate screening all acute stroke patients for dysphagia. However, limited data are available regarding how many patients are screened and how failing a swallowing screen affects patient outcomes. Therefore, we sought to evaluate the impact of dysphagia on clinical outcomes: more frequent pneumonia, malnutrition, sepsis, acute kidney injury, length of stay, and costs were reported in this cohort.Table 1.: Comparison between hospital admission with and without dysphagia among stroke patients (n=1979090).