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

  • Cohen, Seth M1
  • Lekan, Deborah2
  • Risoli, Thomas Jr3
  • Lee, Hui-Jie3
  • Misono, Stephanie4
  • Whitson, Heather E5
  • Raman, Sudha6
  • 1 Duke Voice Care Center, Division of Otolaryngology - Head & Neck Surgery, Duke University Medical Center, DUMC, Box 3805, Durham, NC, 27710, USA. [email protected]
  • 2 School of Nursing, University of North Carolina At Greensboro, Greensboro, NC, USA. [email protected]
  • 3 Duke CTSI Biostatistics, Epidemiology and Research Design Methods Core, Duke University Medical Center, Durham, NC, USA.
  • 4 Lions Voice Clinic, Department of Otolaryngology/Head and Neck Surgery, University of Minnesota, Minneapolis, MN, USA.
  • 5 Duke Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA.
  • 6 Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
Published Article
Publication Date
Dec 07, 2019
DOI: 10.1007/s00455-019-10084-z
PMID: 31811381


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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