Economic and survival burden of dysphagia among inpatients in the United States

0

Economic and survival burden of dysphagia among inpatients in the United States

D. A. Patel, S. Krishnaswami, E. Steger, E. Conover, M. F. Vaezi, M. R. Ciucci, D. O. Francis
Diseases of the Esophagus 2018; 31: 1–7 DOI: 10.1093/dote/dox131

Carga econômica da disfagia e sobrevida em pacientes internados nos Estados Unidos

Autor: Dr. Roberto Dantas

Este trabalho, que incluiu milhões de pacientes internados em hospitais americanos, demonstrou que entre pacientes com diferentes doenças aqueles com disfagia permaneciam mais tempo internados, tinham maior custo para diagnóstico e tratamento, tinham maior chance de serem encaminhados para centros de tratamento após a fase aguda da doença, e maior mortalidade do que entre aqueles sem disfagia. Esta publicação demonstra que pacientes com disfagia exigem mais do hospital onde são internados do que aqueles com as mesmas doenças, mas sem disfagia. Disfagia é um sintoma que precisa tratamento específico, para manutenção do estado nutricional, evitar complicações e diminuir a mortalidade. Nos dias de hoje existem tratamentos para disfagia, que devem estar disponíveis em todos hospitais que possam receber este tipo de paciente.

SUMMARY

The inpatient burden of dysphagia has primarily been evaluated in patients with stroke. It is unclear
whether dysphagia, irrespective of cause, is associated with worse clinical outcomes and higher costs compared to inpatients with similar demographic, hospital, and clinical characteristics without dysphagia. The aim of this study is to assess how a dysphagia diagnosis affects length of hospital stay (LOS), costs, discharge disposition, and inhospital mortality among adult US inpatients. Annual and overall dysphagia prevalence, LOS, hospital charges, inpatient care costs, discharge disposition, and in-hospital mortality were measured using the AHRQ Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (2009–2013). Patients aged 45 years or older with ≤180 days of stay in hospital with and without dysphagia were included. Multivariable survey regression methods with propensity weighting were used to assess associations between dysphagia and different outcomes. Overall, 2.7 of 88 million (3.0%) adult US inpatients had a dysphagia diagnosis (50.2% male, 72.4% white, 74.6% age 65–90 years) and prevalence increased from 408,035 (2.5% of admissions) in 2009 to 656,655 (3.3%) in 2013. After inverse probability of treatment weighting adjustment, mean hospital LOS in patients with dysphagia was 8.8 days (95% CI 8.66–8.90) compared to 5.0 days (95% CI 4.97–5.05) in the non-dysphagia group (P < 0.001). Total inpatient costs were a mean $6,243 higher among those with dysphagia diagnoses ($19,244 vs. 13,001, P < 0.001). Patients with dysphagia were 33.2% more likely to be transferred to post-acute care facility (71.9% vs. 38.7%, P < 0.001) with an adjusted OR of 2.8 (95% CI 2.73–2.81, P < 0.001). Compared to non-cases, adult patients with dysphagia were 1.7 times more likely to die in the hospital (95% CI 1.67–1.74). Dysphagia affects 3.0% of all adult US inpatients (aged 45–90 years) and is associated with a significantly longer hospital length of stay, higher inpatient costs, a higher likelihood of discharge to post-acute care facility, and inpatient mortality when compared to those with similar patient, hospital size, and clinical characteristics without dysphagia. Dysphagia has a substantial health and cost burden on the US healthcare system.