Dysphagia found to increase length of hospital stay and mortality risk

Researchers from Mount Sinai School of Medicine have found that hospitalized patients with dysphagia, or difficulty swallowing, averaged a 40 percent longer hospital stay than patients without the condition. They also had a generally poorer prognosis. The research is published in the August issue of Archives of Otolaryngology–Head & Neck Surgery, one of the JAMA/Archives journals.

The researchers evaluated more than 77 million hospital admissions during 2005-2006, 271,983 of which were associated with dysphagia, as indicated by the National Hospital Discharge Survey (NHDS). The median number of days in the hospital for patients with dysphagia was 4.04, compared to 2.40 days for patients without dysphagia. Mortality increased significantly in patients with dysphagia and disk disorders or heart disease, and those undergoing rehabilitation had a greater than 13-fold increased risk of mortality. Patients ages 75 and older were twice as likely to have dysphagia.

"Our study shows that dysphagia has a significant impact on length of stay and prognostic indicators," said Kenneth W. Altman, MD, PhD, Associate Professor of Otolaryngology, lead author on the study. "Early identification of dysphagia and therapeutic intervention are critical to preventing further complications in these patients and reducing length of stay. These data indicate the necessity for health care providers to prevent or diagnose this condition early to reduce complications."

The impact of dysphagia on hospital resources was also substantial. Patients with dysphagia are often at risk of aspirating, which often requires antibiotic use and intubation. The increased mortality risk associated with the condition also increases end-of-life costs. Using a measurement tool previously developed for community-acquired pneumonia, the researchers estimated the cost of dysphagia at nearly $550 million over the two year period.

"With our country moving into a value-based health care system, we will truly feel the impact of the costs associated with dysphagia," said Dr. Altman. "As such, it's important to develop strategies to prevent and treat this debilitating condition to reduce those costs."

Dysphagia is present with a number of serious conditions, which may contribute to mortality risk. The most common conditions associated with dysphagia were stroke, aspiration pneumonia, urinary tract infection, esophageal disease, fluid or electrolyte disorder, and congestive heart failure. Patients with these conditions are especially susceptible to aspiration. The authors emphasize that dysphagia is severely underreported, due to minor cases not being documented, or clinicians seeing it as a side effect of another condition rather than a condition itself.

"Hospitals should implement assessment tools to identify dysphagia in high risk patients, including the elderly, stroke and rehabilitation patients, and patients with malnutrition, neurodegenerative disease, pneumonia, or heart disease," said Dr. Altman. "At Mount Sinai, we are making every effort to identify these patients early to prevent further complications."

The Mount Sinai Medical Center encompasses both The Mount Sinai Hospital and Mount Sinai School of Medicine. Established in 1968, Mount Sinai School of Medicine is one of few medical schools embedded in a hospital in the United States. It has more than 3,400 faculty in 32 departments and 15 institutes, and ranks among the top 20 medical schools both in National Institute of Health funding and by U.S. News & World Report. The school received the 2009 Spencer Foreman Award for Outstanding Community Service from the Association of American Medical Colleges.

The Mount Sinai Hospital, founded in 1852, is a 1,171-bed tertiary- and quaternary-care teaching facility and one of the nation's oldest, largest and most-respected voluntary hospitals. In 2009, U.S. News & World Report ranked The Mount Sinai Hospital among the nation's top 20 hospitals based on reputation, patient safety, and other patient-care factors. Nearly 60,000 people were treated at Mount Sinai as inpatients last year, and approximately 530,000 outpatient visits took place.

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