Economic costs of dysphagia among hospitalized patients

Abstract

Objectives/hypothesis: Difficulties swallowing may lead to aspiration pneumonia and death. In a hospital setting where patients are admitted for other causes, we hypothesized that the additional burden of a swallow problem would increase length of stay, rate of pneumonia, cost, readmissions, and morbidity compared to those without dysphagia.

Study design: Retrospective parallel cohort study.

Methods: A study of patients admitted to the hospital with hip/femur fracture was completed. Two groups were identified and compared: those with a coded diagnosis of dysphagia (n = 165) in addition to hip/femur fracture (HF + D), and a group with hip fracture alone (HF-D) (n = 2,288) (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification). Number of inpatient days, cost per patient, diagnosis of pneumonia, 30-day readmission, and mortality rates were compared.

Results: For those in the HF + D group, mean age was 85 years compared to 78 years in the HF-D group (P < .05); length of stay was 32 days, more than twice that of the HF-D group (14 days) (P < .05). Mortality within 30 days of admission was significantly higher (18% vs. 4%,respectively) but 30-day readmission rate was similar (8% vs. 11%, respectively). Rate of aspiration pneumonia was 14 times greater in HF + D (9.7%) compared with HF-D (0.7%). Average admission cost was NZD$36,913 (HF + D) compared with NZD$22,222 (HF-D) (P < .05).

Conclusions: Complaint of dysphagia, in addition to hip fracture, increases a patient's average admission cost by 60%. It is associated with increased aspiration pneumonia and greater mortality. Dysphagia screening at admission to hospital would allow early identification of swallow compromise and may prevent complications and reduce costs.

Level of evidence: 3b Laryngoscope, 130:974-979, 2020.

Keywords: Deglutition; costs and cost analysis; dysphagia; pneumonia.