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BMC Health Services Research
Published in: BMC Health Services Research 1/2018

Open Access 01-12-2018 | Research article

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

Authors: Stacie Attrill, Sarahlouise White, Joanne Murray, Sue Hammond, Sebastian Doeltgen

Published in: BMC Health Services Research | Issue 1/2018

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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.
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Literature
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):935–47.CrossRefPubMed
2.
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):123–30.CrossRefPubMed
3.
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.CrossRefPubMedPubMedCentral
4.
National Institute for Health and Care Excellence. Cancer of the upper aerodigestive tract: assessment and management in people aged 16 and over. UK; 2016.
5.
6.
Kalf JG, de Swart BJ, Bloem BR, Munneke M. Prevalence of oropharyngeal dysphagia in Parkinson’s disease: a meta-analysis. Parkinsonism Relat Disord. 2012;18(4):311–5.CrossRefPubMed
7.
Correia MI, Waitzber DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr. 2003;22(3):235–9.CrossRefPubMed
8.
Garlo K, Williams D, Lucas L, Wong R, Botler J, Abramson S, Parker MG. Severity of Anemia predicts hospital length of stay but not readmission in patients with chronic kidney disease. Medicine (Baltimore). 2015;94(25):e964.CrossRef
9.
Thomason JWW, Shintani A, Peterson JF, Pun BT, Jackson JC, Ely EW. Intensive care unit delirium is an independent predictor of longer hospital stay: a prospective analysis of 261 non-ventilated patients. CriticalCare. 2005;9(4):R375–81.
10.
Ekberg O, Hamdy S, Woisard V, Wuttge–Hannig A, Ortega P. Social and psychological burden of dysphagia: its impact on diagnosis and treatment. Dysphagia. 2002;17(2):139–46.CrossRefPubMed
11.
Altman KW, Yu GP, Schaefer SD. Consequence of dysphagia in the hospitalized patient: impact on prognosis and hospital resources. Arch Otolaryngol Head Neck Surg. 2010;136(8):784–9.CrossRefPubMed
12.
Smithard DG, O’Neill PA, Parks C, Morris J. Complications and outcome after acute stroke. Does dysphagia matter? Stroke. 1996;27:1200–4.CrossRefPubMed
13.
Smithard DG, Smeeton NC, Wolfe CD. Long-term outcome after stroke: does dysphagia matter? Age Ageing. 2007;36:90–4.CrossRefPubMed
14.
Marik PE, Kaplan D. Aspiration pneumonia and dysphagia in the elderly. Chest. 2003;124(1):328–36.CrossRefPubMed
15.
16.
Genther DJ, Gourin CG. Effect of comorbidity on short-term outcomes and cost of care after head and neck cancer surgery in the elderly. Head Neck. 2015;37(5):685–93.CrossRefPubMed
17.
Gourin CG, Starmer HM, Herbert RJ, Frick KD, Forastiere AA, Quon H, Eisele DW, Dy SM. Quality of care and short- and long-term outcomes of laryngeal cancer care in the elderly. Laryngoscope. 2015;125(10):2323–9.CrossRefPubMed
18.
Patel DA, Krishnaswami S, Steger E, Conover E, Vaezi MF, Ciucci MR, Francis DO. Economic and survival burden of dysphagia among inpatients in the United States. Dis Esophagus. 2017;31(1):1–7.
19.
20.
Moher DLA, Tetzlaff J, Altman DG, The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med (OPEN ACCESS). 2009;6(7):e1000097.CrossRef
21.
The Cochrane Collaboration. Review Manager (RevMan) [Computer program]. Version 5.3. Copenhagen: The Nordic Cochrane Centre, the Cochrane Collaboration; 2014.
22.
Australian Institute of Health and Welfare. Episode of admitted patient care—length of stay (excluding leave days). Canberra: Welfare AIoHa.
23.
24.
25.
26.
Rao N, Brady S, Chaudhuri G, Ruroede K, Caldwell R. Stroke rehabilitation: does dysphagia make a difference for outcomes? Neurorehabil Neural Repair. 2005;19(4):388–388 381p.
27.
Arnold M, Liesirova K, Broeg-Morvay A, Meisterernst J, Schlager M, Mono ML, El-Koussy M, Kagi G, Jung S, Sarikaya H. Dysphagia in acute stroke: incidence, burden and impact on clinical outcome. PLoS One. 2016;11(2):e0148424.CrossRefPubMedPubMedCentral
28.
Bradley JF 3rd, Jones MA, Farmer EA, Fann SA, Bynoe R. Swallowing dysfunction in trauma patients with cervical spine fractures treated with halo-vest fixation. J Trauma. 2011;70(1):46–8. discussion 48-50CrossRefPubMed
29.
Hogue CW Jr, Lappas GD, Creswell LL, Ferguson TB Jr, Sample M, Pugh D, Balfe D, Cox JL, Lappas DG. Swallowing dysfunction after cardiac operations. Associated adverse outcomes and risk factors including intraoperative transesophageal echocardiography. J Thorac Cardiovasc Surg. 1995;110(2):517–22.CrossRefPubMed
30.
Young EC, Durant-Jones L. Developing a dysphagia program in an acute care hospital: a needs assessment. Dysphagia. 1990;5(3):159–65.CrossRefPubMed
31.
Nilsson H, Ekberg O, Olsson R, Hindfelt B. Dysphagia in stroke: a prospective study of quantitative aspects of swallowing in dysphagic patients. Dysphagia. 1998;13(1):32–8.CrossRefPubMed
32.
33.
Westergren A, Hallberg IR, Ohlsson O. Nursing assessment of dysphagia among patients with stroke. Scand J Caring Sci. 1999;13(4):274–82.CrossRefPubMed
34.
Langdon C, Lee A, Binns C. Dysphagia in acute ischaemic stroke: severity, recovery and relationship to stroke subtype. J Clin Neurosci. 2007;14(7):630–4.CrossRefPubMed
35.
Chaw E, Shem K, Castillo K, Wong SL, Chang J. Dysphagia and associated respiratory considerations in cervical spinal cord injury. Top Spinal Cord Inj Rehabil. 2012;18(4):291–9.CrossRefPubMed
36.
Chen CM, Ke YL. Predictors for total medical costs for acute hemorrhagic stroke patients transferred to the rehabilitation ward at a regional hospital in Taiwan. Top Stroke Rehabil. 2016;23(1):44–51.CrossRef
37.
Falsetti P, Acciai C, Palilla R, Bosi M, Carpinteri F, Zingarelli A, Pedace C, Lenzi L. Oropharyngeal dysphagia after stroke: incidence, diagnosis, and clinical predictors in patients admitted to a neurorehabilitation unit. J Stroke Cerebrovasc Dis. 2009;18(5):329–35.CrossRefPubMed
38.
Ferraris VA, Ferraris SP, Moritz DM, Welch S. Oropharyngeal dysphagia after cardiac operations. Ann Thorac Surg. 2001;71(6):1792–5. discussion 1796CrossRefPubMed
39.
Guyomard V, Fulcher RA, Redmayne O, Metcalf AK, Potter JF, Myint PK. Effect of dysphasia and dysphagia on inpatient mortality and hospital length of stay: a database study. J Am Geriatr Soc. 2009;57(11):2101–6.CrossRefPubMed
40.
Macht M, King CJ, Wimbish T, Clark BJ, Benson AB, Burnham EL, Williams A, Moss M. Post-extubation dysphagia is associated with longer hospitalization in survivors of critical illness with neurologic impairment. Critical care (London, England). 2013;17(3):R119.CrossRef
41.
Macht M, Wimbish T, Clark BJ, Benson AB, Burnham EL, Williams A, Moss M. Postextubation dysphagia is persistent and associated with poor outcomes in survivors of critical illness. Critical care (London, England). 2011;15(5):R231.CrossRef
42.
Odderson IR, Keaton JC, McKenna BS. Swallow management in patients on an acute stroke pathway: quality is cost effective. Arch Phys Med Rehabil. 1995;76:1130–3.CrossRefPubMed
43.
Teasell R, Foley N, Fisher J, Finestone H. The incidence, management, and complications of dysphagia in patients with medullary strokes admitted to a rehabilitation unit. Dysphagia. 2002;17(2):115–20.CrossRefPubMed
44.
Tian H, Abouzaid S, Sabbagh MN, Chen W, Gabriel S, Kahler KH, Kim E. Health care utilisation and costs among patients with AD with and without dysphagia. Alzheimer Dis Assoc Disord. 2013;27(2):138–44.CrossRefPubMed
45.
Chan JY, Li RJ, Gourin CG. Short-term outcomes and cost of care of treatment of head and neck paragangliomas. Laryngoscope. 2013;123(7):1645–51.
46.
Semenov YR, Starmer HM, Gourin CG. The effect of pneumonia on short-term outcomes and cost of care after head and neck cancer surgery. Laryngoscope. 2012;122(9):1994–2004
47.
Starmer HM, Riley LH, 3rd, Hillel AT, Akst LM, Best SR, Gourin CG. Dysphagia, shortterm outcomes, and cost of care after anterior cervical disc surgery. Dysphagia. 2014;29(1):68–77.
48.
Ward BK, Francis HW, Best SR, Starmer HM, Akst LM, Gourin CG. National prevalence and impact of perioperative vagus nerve injury in vestibular schwannoma. Laryngoscope. 2012;122(12):2824–31.
49.
Chen CJ, Saulle D, Fu KM, Smith JS, Shaffrey CI. Dysphagia following combined anterior-posterior cervical spine surgeries Clinical article. Journal of Neurosurgery: Spine. 2013;19(3)279–87.
50.
Metadata
Title
Impact of oropharyngeal dysphagia on healthcare cost and length of stay in hospital: a systematic review
Authors
Stacie Attrill
Sarahlouise White
Joanne Murray
Sue Hammond
Sebastian Doeltgen
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2018
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-018-3376-3

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