Clinical and Economic Outcomes Associated with Dysphagia in Hospitalized Patients with Parkinson’s Disease

Article type: Research Article

Authors: Di Luca, Daniel G.^{a; *} | McArthur, Eric W.^b | Willis, Allison^c | Martino, Rosemary^{d; e; f; g} | Marras, Connie^{a; d}

Affiliations: [a] Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson’s Disease Research, Toronto Western Hospital and University of Toronto, Toronto, ON, Canada | [b] London Health Sciences Centre, London, ON, Canada | [c] Departments of Neurology and Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA | [d] Krembil Research Institute, University Health Network, Toronto, ON, Canada | [e] Department of Speech Language Pathology, University of Toronto, Toronto, ON, Canada | [f] Rehabilitation Science Institute, University of Toronto, Toronto, ON, Canada | [g] Department of Otolaryngology- Head and Neck Surgery, University of Toronto, Toronto, ON, Canada

Correspondence: [*] Correspondence to: Daniel G. Di Luca, MD, Movement Disorders Clinic, Toronto Western Hospital, Division of Neurology, Department of Medicine, University of Toronto, Ontario, Canada, 399 Bathurst Street, McL 7-412, Toronto, Ontario M5T 2S8, Canada. E-mail: Daniel.garbindiluca@uhnresearch.ca.

Abstract: Background:Dysphagia is a frequent complication that may increase morbidity and mortality in Parkinson’s disease (PD). Nevertheless, there is limited data on its objective impact on healthcare outcomes. Objective:To investigate the outcomes associated with dysphagia in hospitalized patients with PD and associated healthcare costs and utilization. Methods:We performed a retrospective cohort study using the National Inpatient Sample (NIS) data from 2004 to 2014. A multivariable regression analysis was adjusted for demographic, and comorbidity variables to examine the association between dysphagia and associated outcomes. Logistic and negative binomial regressions were used to estimate odds or incidence rate ratios for binary and continuous outcomes, respectively. Results:We identified 334,395 non-elective hospitalizations of individuals with PD, being 21,288 (6.36%) associated with dysphagia. Patients with dysphagia had significantly higher odds of negative outcomes, including aspiration pneumonia (AOR 7.55, 95%CI 7.29–7.82), sepsis (AOR 1.91, 95%CI 1.82–2.01), and mechanical ventilation (AOR 2.00, 95%CI 1.86–2.15). For hospitalizations with a dysphagia code, the length of stay was 44%(95%CI 1.43–1.45) longer and inpatient costs 46%higher (95%CI 1.44–1.47) compared to those without dysphagia. Mortality was also substantially increased in individuals with PD and dysphagia (AOR 1.37, 95%CI 1.29–1.46). Conclusion:In hospitalized patients with PD, dysphagia was a strong predictor of adverse clinical outcomes, and associated with substantially prolonged length of stay, higher mortality, and care costs. These results highlight the need for interventions focused on early recognition and prevention of dysphagia to avoid complications and lower costs in PD patients.

Keywords: Dysphagia, Parkinson’s disease, neurodegenerative diseases, healthcare costs

DOI: 10.3233/JPD-212798

Journal: Journal of Parkinson's Disease, vol. 11, no. 4, pp. 1965-1971, 2021