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Association Between Dysphagia and Inpatient Outcomes Across Frailty Level Among Patients ≥ 50 Years of Age

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Abstract

Frail patients may have heightened risk of dysphagia, a potentially modifiable health factor. Our aim is to examine whether the relationship between dysphagia and adverse health outcomes differs by frailty conditions among inpatients ≥ 50 years of age. Medical or surgical hospitalizations among patients ≥ 50 years of age in the Healthcare Cost and Utilization Project’s National Inpatient Sample from 2014 through the first three quarters of 2015 were included. Adverse outcomes included length of stay (LOS), hospital costs, in-hospital mortality, discharge status, and medical complications. Dysphagia was determined by ICD-9-CM codes. Frailty was defined as (a) ≥ 1 condition in the10-item Johns Hopkins Adjusted Clinical Groups (ACG) frailty measure and a frailty index for the (b) ACG and (c) a 19-item Frailty Risk Score (FRS) categorized as non-frail, pre-frail, and frail. Weighted generalized linear models for complex survey designs using generalized estimating equations were performed. Of 6,230,114 unweighted hospitalizations, 4.0% had a dysphagia diagnosis. Dysphagia presented in 3.1% and 11.0% of non-frail and frail hospitalizations using the binary ACG (p < 0.001) and in 2.9%, 7.9%, and 16.0% of non-frail, pre-frail, and frail hospitalizations using the indexed FRS (p < 0.001). Dysphagia was associated with greater LOS, higher total costs, increased non-routine discharges, and more medical complications among both frail and non-frail patients using the three frailty definitions. Dysphagia was associated with adverse outcomes in both frail and non-frail medical or surgical hospitalizations. Dysphagia management is an important consideration for providers seeking to reduce risk in vulnerable populations.

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Funding

There is no study sponsor. Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR002553 and UL1TR001117, a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research as well as NIH ULI RR033183 & KL2 RR0333182. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Duke Voice Care Center, Division of Otolaryngology – Head & Neck Surgery, Duke University Medical Center, DUMC, Box 3805, Durham, NC, 27710, USA

    Seth M. Cohen

  2. School of Nursing, University of North Carolina At Greensboro, Greensboro, NC, USA

    Deborah Lekan

  3. Duke CTSI Biostatistics, Epidemiology and Research Design Methods Core, Duke University Medical Center, Durham, NC, USA

    Thomas Risoli Jr. & Hui-Jie Lee

  4. Lions Voice Clinic, Department of Otolaryngology/Head and Neck Surgery, University of Minnesota, Minneapolis, MN, USA

    Stephanie Misono

  5. Duke Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA

    Heather E. Whitson

  6. Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA

    Sudha Raman

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  1. Seth M. Cohen
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  2. Deborah Lekan
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Correspondence to Seth M. Cohen or Deborah Lekan.

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Conflict of interest

Seth Cohen is a consultant for Zsquare, Data Safety Monitoring Board Member for Syneos Health, expert witness testimony for defense. Stephanie Misono has NIH K23DC016335 funding from the NIDCD. Heather Whitson is supported by the Duke Claude D. Pepper Older American Independence Center (P30AG028716), the Physical Resilience Indicators and Mechanisms in the Elderly (PRIME) Collaborative (UH2AG056925), and the National Center for Advancing Translational Sciences of the National Institutes of Health (UL1TR002553). Sudha Raman has research support from Glaxo Smith Kline. Deborah Lekan, Thomas Risoli, and Hui-Jie Lee have no disclosures.

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Cohen, S.M., Lekan, D., Risoli, T. et al. Association Between Dysphagia and Inpatient Outcomes Across Frailty Level Among Patients ≥ 50 Years of Age. Dysphagia 35, 787–797 (2020). https://doi.org/10.1007/s00455-019-10084-z

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