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

Seth M. Cohen; Deborah Lekan; Thomas Risoli; Hui Jie Lee; Stephanie Misono; Heather E. Whitson; Sudha Raman

doi:10.1007/s00455-019-10084-z

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

Seth M. Cohen, Deborah Lekan, Thomas Risoli, Hui Jie Lee, Stephanie Misono, Heather E. Whitson, Sudha Raman

Otolaryngology

Research output: Contribution to journal › Article › peer-review

23 Scopus citations

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.

Original language	English (US)
Pages (from-to)	787-797
Number of pages	11
Journal	Dysphagia
Volume	35
Issue number	5
DOIs	https://doi.org/10.1007/s00455-019-10084-z
State	Published - Oct 1 2020

Bibliographical note

Funding Information:
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.

Funding Information:
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.

Publisher Copyright:
© 2019, Springer Science+Business Media, LLC, part of Springer Nature.

Keywords

Deglutition
Deglutition disorders
Dysphagia
Frailty
Inpatient
Outcomes
Swallowing

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

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{\textquoteright}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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author = "Cohen, {Seth M.} and Deborah Lekan and Thomas Risoli and Lee, {Hui Jie} and Stephanie Misono and Whitson, {Heather E.} and Sudha Raman",

note = "Funding Information: 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. Funding Information: 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. Publisher Copyright: {\textcopyright} 2019, Springer Science+Business Media, LLC, part of Springer Nature.",

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N2 - 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.

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

Abstract

Bibliographical note

Keywords

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