Department of Otolaryngology WDHB, Greene i3, WDHB. Miles - Faculty of Speech Science, University of Auckland, Auckland, New Zealand.
Waitemata District Health Board, Auckland, New Zealand.
Laryngoscope. 2020 Apr;130(4):974-979. doi: 10.1002/lary.28194. Epub 2019 Jul 17.
OBJECTIVES/HYPOTHESIS: Difficulties swallowing may lead to aspiration pneumonia and death. In a hospital setting where patients are admitted for other causes, we hypothesized that the additional burden of a swallow problem would increase length of stay, rate of pneumonia, cost, readmissions, and morbidity compared to those without dysphagia.
Retrospective parallel cohort study.
A study of patients admitted to the hospital with hip/femur fracture was completed. Two groups were identified and compared: those with a coded diagnosis of dysphagia (n = 165) in addition to hip/femur fracture (HF + D), and a group with hip fracture alone (HF-D) (n = 2,288) (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification). Number of inpatient days, cost per patient, diagnosis of pneumonia, 30-day readmission, and mortality rates were compared.
For those in the HF + D group, mean age was 85 years compared to 78 years in the HF-D group (P < .05); length of stay was 32 days, more than twice that of the HF-D group (14 days) (P < .05). Mortality within 30 days of admission was significantly higher (18% vs. 4%,respectively) but 30-day readmission rate was similar (8% vs. 11%, respectively). Rate of aspiration pneumonia was 14 times greater in HF + D (9.7%) compared with HF-D (0.7%). Average admission cost was NZD$36,913 (HF + D) compared with NZD$22,222 (HF-D) (P < .05).
Complaint of dysphagia, in addition to hip fracture, increases a patient's average admission cost by 60%. It is associated with increased aspiration pneumonia and greater mortality. Dysphagia screening at admission to hospital would allow early identification of swallow compromise and may prevent complications and reduce costs.
3b Laryngoscope, 130:974-979, 2020.
目的/假设：吞咽困难可能导致吸入性肺炎和死亡。在因其他原因住院的患者中，我们假设与无吞咽困难的患者相比，吞咽问题会增加住院时间、肺炎发生率、成本、再入院率和发病率。
回顾性平行队列研究。
完成了一项对因髋/股骨骨折住院的患者的研究。确定并比较了两组患者：编码诊断为吞咽困难（n = 165）的患者（HF + D）和单纯髋部骨折的患者（HF-D）（n = 2288）（国际疾病分类第十版，澳大利亚修改版）。比较了住院天数、每位患者的成本、肺炎诊断、30 天再入院率和死亡率。
在 HF + D 组中，平均年龄为 85 岁，而 HF-D 组为 78 岁（P <.05）；住院时间为 32 天，是 HF-D 组的两倍多（14 天）（P <.05）。入院后 30 天内死亡率明显较高（分别为 18%和 4%），但 30 天再入院率相似（分别为 8%和 11%）。HF + D 组的吸入性肺炎发生率高出 14 倍（9.7%），而 HF-D 组为 0.7%（P <.05）。HF + D 的平均入院费用为 36913 新西兰元（HF + D），而 HF-D 的平均入院费用为 22222 新西兰元（HF-D）（P <.05）。
除髋部骨折外，吞咽困难的主诉会使患者的平均入院费用增加 60%。它与吸入性肺炎和更高的死亡率有关。在医院入院时进行吞咽困难筛查可以及早发现吞咽困难，并可能预防并发症和降低成本。
3b 喉镜，130：974-979，2020。
