Dysphagia May Lengthen Hospital Stay

Does the presence of dysphagia in hospitalized patients result in prolonged hospital stay and increased morbidity?

Background: Dysphagia is a symptom that may be an indication of swallowing dysfunction. Swallowing dysfunction can result in aspiration, dehydration, malnutrition, pneumonia, pulmonary abscess and death. The implication of swallowing dysfunction on a patient’s hospital stay is uncertain. The authors hypothesize that swallowing dysfunction may have adverse consequences on an individual’s hospital stay. The identification of a significant association may help allocate resources to services that have the potential to improve outcomes and reduce patient morbidity.

Study design: Historical cohort

Setting: National Hospital Discharge Survey (NHDS), representing the hospitalized population of the U.S.

Synopsis: Less than half percent (0.35 percent) of over 77 million hospitalizations were associated with dysphagia. Age was a significant risk factor for a diagnosis of dysphagia, and the rate of dysphagia was more than double (0.73 percent) for persons older than 75 years of age. A diagnosis of dysphagia was associated with a 40 percent increase in the length of hospital stay. Hospitalized patients undergoing rehabilitation with a diagnosis of dysphagia were 13.7 times more likely to die (95 percent confidence interval [CI] for relative risk [RR] = 3.5 – 54.5). Hospitalized patients with an intervertebral disc disorder and a diagnosis of dysphagia were 3.7 times (95 percent CI = 0.3 – 41.4) more likely to die, and patients with coronary atherosclerosis and a diagnosis of dysphagia were 2.6 times (95 percent CI = 1.2 – 5.6) more likely to die.

Bottom line: A diagnosis of dysphagia in hospitalized patients is associated with advancing age, a prolonged hospital stay and a significantly elevated (13X) risk of death in patients undergoing rehabilitation. According to calculated summary estimations performed by the authors, dysphagia may result in an additional 223,027 hospital days and an additional $547,307,964 in health care costs per year.

These results should be interpreted with caution, because NHDS data do not rely on stringent criteria for a diagnosis of dysphagia or swallowing dysfunction. Thus, the survey is susceptible to misclassification bias. NHDS estimations, however, are likely to be underestimated, and the true effects of dysphagia on hospital length of stay should be even greater than those reported in this investigation. These data will serve as a useful benchmark and catalyst for prospective investigation.

Citation: Altman KW, Yu GP, Schaefer SD. Consequence of dysphagia in the hospitalized patient: impact on prognosis and hospital resources. Arch Otolaryngol Head Neck Surg. 2010;136(8):784-789.

—Reviewed by Peter C. Belafsky, MD, PhD