Dysphagia after ischemic and hemorrhagic stroke: A propensity-matched 20-year analysis of the national inpatient sample

Vikram Vasan; Trevor A Hardigan; Muhammad Ali; Margaret Downes; Alex Devarajan; Christina P Rossitto; Braxton R Schuldt; Ian C Odland; Christopher P Kellner; Johanna T Fifi; J Mocco; Shahram Majidi

doi:10.1016/j.jstrokecerebrovasdis.2023.107295

Dysphagia after ischemic and hemorrhagic stroke: A propensity-matched 20-year analysis of the national inpatient sample

J Stroke Cerebrovasc Dis. 2023 Sep;32(9):107295. doi: 10.1016/j.jstrokecerebrovasdis.2023.107295. Epub 2023 Aug 4.

Affiliations

¹ Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA. Electronic address: vikram.vasan@icahn.mssm.edu.
² Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA.

PMID: 37544059
DOI: 10.1016/j.jstrokecerebrovasdis.2023.107295

Abstract

Objective: Dysphagia is a common symptom of acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH), but little is known surrounding national trends of this post-stroke condition. Hence, this study aimed to identify the risk factors for dysphagia following AIS and ICH and evaluate in-hospital outcomes in these patients.

Methods: The 2000-2019 Nationwide Inpatient Sample was queried for patients admitted with AIS (ICD9 433, 43401, 43411, 43491, ICD-10 I63) and ICH (ICD9 431, 432.9, ICD-10 I61, I62.9). Univariate analysis with t-tests or chi-square performed as appropriate. A 1:1 nearest neighbor propensity score matched cohort was generated. Variables with standardized mean differences >0.1 were used in multivariable regression to generate adjusted odds ratios (AOR)/β-coefficients for the presence of dysphagia on outcomes.

Results: Of 10,415,286 patients with AIS, 956,662 (9.2%) had in-hospital dysphagia. Total of 2,000,868 patients with ICH were identified; 203,511 (10.2%) had in-hospital dysphagia. Patients with dysphagia after AIS were less likely to experience in-hospital mortality (OR 0.61;95%CI: 0.60-0.63) or be discharged home (AOR 0.51;95%CI: 0.51-0.52), had increased length of stay (Beta-coefficient = 0.43 days; 95%CI: 0.36-0.50), and had increased hospital charges ($14411.96;95%CI: 13565.68-15257.44) (all p < 0.001). Patients with dysphagia after ICH were less likely to experience in-hospital mortality (AOR 0.39;95%CI: 0.37-0.4), less likely to be discharged home (AOR 0.59,95%CI:0.57-0.61), have longer hospital stay (Beta-coefficient = 1.99 days;95%CI: 1.78-2.21), and increased hospital charges ($28251.93; 95%CI: $25594.57-30909.28)(all p < 0.001).

Conclusion: This is the first study to report on national trends in patients with dysphagia after AIS and ICH. These patients had longer hospital LOS, worse functional outcomes at discharge, and higher hospital costs.

Keywords: Dysphagia; Epidemiology; Intracerebral hemorrhage; Ischemic stroke; Outcome.

MeSH terms

Cerebral Hemorrhage / complications
Cerebral Hemorrhage / diagnosis
Deglutition Disorders* / diagnosis
Deglutition Disorders* / epidemiology
Deglutition Disorders* / etiology
Hemorrhagic Stroke*
Hospital Mortality
Humans
Inpatients
Ischemic Stroke*
Stroke* / complications
Stroke* / diagnosis
Stroke* / therapy