Original Article

CME Article: Effect of Dysphagia on Hospital Outcomes and Readmissions in Patients with Human Immunodeficiency Virus

Authors: Rosemary Nustas, MD, Raj Dalsania, MD, Jason Brown, MD, Srikrishna V. Patnana, MD, Emad Qayed, MD, MPH

Abstract

Objectives: Dysphagia is a common symptom in patients hospitalized with human immunodeficiency virus (HIV). There are limited data on the relation between dysphagia and important hospital outcomes. The aim of our study was to assess the impact of dysphagia on hospital costs, length of stay (LOS), mortality, and 30-day readmission rates in HIV patients hospitalized with dysphagia.

Methods: We used the Nationwide Readmissions Database to identify all adult hospitalizations with HIV between January 2010 and September 2015. We stratified cases according to the presence of dysphagia (International Classification of Diseases, Ninth Revision, Clinical Modification code 787.2) as a primary or secondary diagnosis, and compared clinical and hospital characteristics between the two groups. Multivariable regression models were used to compare LOS, total hospital costs, in-hospital mortality, 30-day mortality, and 30-day readmission rates between the two groups.

Results: A total of 206,332 hospitalized patients with HIV were included in the study. Of these, 8699 (4.2%) patients had dysphagia. Patients with dysphagia were more likely to have Candida esophagitis (26.8% vs 3.6%), esophageal strictures (3.1% vs 0.2%), and malnutrition (41.6% vs 17.6%); and they were more likely to undergo upper endoscopy (23.2% vs 3.8%) and percutaneous feeding tube placement (9.2% vs 0.7%), all P < 0.0001. On multivariate analysis, dysphagia was associated with longer LOS (12 vs 7.4 days; P < 0.0001), higher hospitalization cost ($32,993 vs $21,813, P < 0.0001), and increased 30-day readmissions (24% vs 20.8%, adjusted odds ratio 1.19; 95% confidence interval 1.12–1.25; P < 0.0001). Patients with dysphagia had higher in-hospital mortality (4.7% vs 3.5%) but this did not reach statistical significance (adjusted odds ratio 1.01; 95% confidence interval 0.91–1.12; P = 0.86).

Conclusion: In hospitalized patients with HIV, dysphagia is a significant independent predictor of longer LOS, higher costs, and higher rates of 30-day readmissions. These findings highlight the importance of optimizing treatment of dysphagia in patients with HIV to mitigate its negative impact on patient and hospital outcomes.
Posted in: Infectious Disease143 Acquired Immunodeficiency Syndrome (AIDS) And Human Immunodeficiency Virus (HIV) Infection20

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References

1. Monkemuller KE, Lazenby AJ, Lee DH, et al. Occurrence of gastrointestinal opportunistic disorders in AIDS despite the use of highly active antiretroviral therapy. Dig Dis Sci 2005;50:230–234.
 
2. Huppmann AR, Orenstein JM. Opportunistic disorders of the gastrointestinal tract in the age of highly active antiretroviral therapy. Hum Pathol 2010; 41:1777–1787.
 
3. 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;136:784–789.
 
4. Duggan JM, Akpanudo B, Shukla V, et al. Alternative antiretroviral therapy formulations for patients unable to swallow solid oral dosage forms. Am J Health Syst Pharm 2015;72:1555–1565.
 
5. Suzuki T, Hara N, Osa M, et al. Efficacy of switching to dolutegravir plus rilpivirine, the small-tablet regimen, in patients with dysphagia: two case reports. J Pharm Health Care Sci 2017;3:23.
 
6. Paranji S, Paranji N, Wright S, et al. A nationwide study of the impact of dysphagia on hospital outcomes among patients with dementia. Am J Alzheimers Dis Other Demen 2017;32:5–11.
 
7. Starmer HM. Dysphagia in head and neck cancer: prevention and treatment. Curr Opin Otolaryngol Head Neck Surg 2014;22:195–200.
 
8. Starmer HM, Riley LH 3rd, Hillel AT, et al. Dysphagia, short-term outcomes, and cost of care after anterior cervical disc surgery. Dysphagia 2014;29:68–77.
 
9. Kaysar M, Augustine T, Jim L, et al. Predictors of length of stay between the young and aged in hospitalized community-acquired pneumonia patients. Geriatr Gerontol Int 2008;8:227–233.
 
10. Healthcare Cost and Utilization Project (HCUP). Agency for Healthcare Research and Quality. NRD description of data elements. https://www. hcup-us.ahrq.gov/db/nation/nrd/nrddbdocumentation.jsp. Published 2016. Accessed September 6, 2021.
 
11. Moore BJ, White S, Washington R, et al. Identifying increased risk of readmission and in-hospital mortality using hospital administrative data: the AHRQ Elixhauser Comorbidity Index. Med Care 2017;55:698–705.
 
12. Hayes PC, Davis JM, Lewis JA, et al. Meta-analysis of value of propranolol in prevention of variceal haemorrhage. Lancet 1990;336:153–156.
 
13. Woolard S, Qayed E. Effect of CD4 count on the etiology of esophageal disease in HIV patients: 406. Am J Gastroenterol 2017;112:S216–S217.
 
14. Patel DA, Krishnaswami S, Steger E, et al. Economic and survival burden of dysphagia among inpatients in the United States. Dis Esophagus 2018;31:1–7.