Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2018 Aug 2;18(1):594.
doi: 10.1186/s12913-018-3376-3.

Impact of oropharyngeal dysphagia on healthcare cost and length of stay in hospital: a systematic review

Stacie Attrill  1 , Sarahlouise White  2 , Joanne Murray  2 , Sue Hammond  3 , Sebastian Doeltgen  2   4
Affiliations
Meta-Analysis

Impact of oropharyngeal dysphagia on healthcare cost and length of stay in hospital: a systematic review

Stacie Attrill et al. BMC Health Serv Res. .

Abstract

Background: Healthcare systems internationally are under an ever-increasing demand for services that must be delivered in an efficient, effective and affordable manner. Several patient-related and organisational factors influence health-care expenditure and utilisation, including oropharyngeal dysphagia. Here, we present a systematic review of the literature and meta-analyses investigating how oropharyngeal dysphagia influences healthcare utilisation through length of stay (LOS) and cost.

Methods: Using a standardised approach, eight databases were systematically searched for relevant articles reporting on oropharyngeal dysphagia attributable inpatient LOS and healthcare costs through June 2016. Study methodologies were critically appraised and where appropriate, extracted LOS data were analysed in an overall summary statistic.

Results: Eleven studies reported on cost data, and 23 studies were included reporting on LOS data. Descriptively, the presence of dysphagia added 40.36% to health care costs across studies. Meta-analysis of all-cause admission data from 13 cohort studies revealed an increased LOS of 2.99 days (95% CI, 2.7, 3.3). A subgroup analysis revealed that admission for stroke resulted in higher and more variable LOS of 4.73 days (95% CI, 2.7, 7.2). Presence of dysphagia across all causes was also statistically significantly different regardless of geographical location: Europe (8.42 days; 95% CI, 4.3; 12.5), North America (3.91 days; 95% CI, 3.3, 4.5). No studies included in meta-analysis were conducted in Asia.

Conclusions: This systematic review demonstrated that the presence of oropharyngeal dysphagia significantly increases healthcare utilisation and cost, highlighting the need to recognise oropharyngeal dysphagia as an important contributor to pressure on healthcare systems.

Keywords: Costs; Expenditure; Financial; Meta-analysis; Swallowing.

PubMed Disclaimer

Conflict of interest statement

Not applicable.

Not applicable.

The Authors declare that they have no competing interests.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flowchart of study identification (adapted from Moher, et al., [20])
Fig. 2
Fig. 2
Meta-analysis of dysphagia attributable LOS data reported in cohort studies of patients presenting with stroke
Fig. 3
Fig. 3
Dysphagia increases LOS, regardless of admission cause
Fig. 4
Fig. 4
a Analysis of cohort studies. b. Analysis of cross section studies
Fig. 5
Fig. 5
a Analysis by region: Northern America. b. Analysis by region: Europe
See this image and copyright information in PMC

References

    1. Polverejan E, Gardiner JC, Bradley CJ, Holmes-Rovner M, Rovner D. Estimating mean hospital cost as a function of length of stay and patient characteristics. Health Econ. 2003;12(11):935–947. doi: 10.1002/hec.774. - DOI - PubMed
    1. Taheri PA, Butz DA, Greenfield LJ. Length of stay has minimal impact on the cost of hospital admission. J Am Coll Surg. 2000;191(2):123–130. doi: 10.1016/S1072-7515(00)00352-5. - DOI - PubMed
    1. van Oostveen CJ, Ubbink DT, Huis in het Veld JG, Bakker PJ, Vermeulen H. Factors and models associated with the amount of hospital care services as demanded by hospitalized patients: a systematic review. PLoS One. 2014;9(5):e98102. doi: 10.1371/journal.pone.0098102. - DOI - PMC - PubMed
    1. National Institute for Health and Care Excellence. Cancer of the upper aerodigestive tract: assessment and management in people aged 16 and over. UK; 2016. - PubMed
    1. Stroke Foundation. Clinical Guidelines for Stroke Management 2017. Melbourne Australia. Retrieved from: https://informme.org.au/en/Guidelines/Clinical-Guidelines-for-Stroke-Man....