Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA.
Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA.
J Stroke Cerebrovasc Dis. 2023 Sep;32(9):107295. doi: 10.1016/j.jstrokecerebrovasdis.2023.107295. Epub 2023 Aug 4.
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.
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.
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).
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.
吞咽困难是急性缺血性中风（AIS）和脑出血（ICH）的常见症状，但对于这种中风后状况的全国趋势知之甚少。因此，本研究旨在确定 AIS 和 ICH 后吞咽困难的风险因素，并评估这些患者的住院治疗结局。
2000 年至 2019 年，通过全美住院患者样本（NIS）调查了因 AIS（ICD9 433、43401、43411、43491、ICD-10 I63）和 ICH（ICD9 431、432.9、ICD-10 I61、I62.9）住院的患者。适当使用 t 检验或卡方进行单变量分析。生成了 1:1 最近邻倾向评分匹配队列。使用标准化均数差值>0.1 的变量，在多变量回归中生成存在吞咽困难的调整比值比（AOR）/β 系数，以预测结局。
在 10415286 例 AIS 患者中，956662 例（9.2%）存在住院期间吞咽困难。共确定了 2000868 例 ICH 患者；203511 例（10.2%）存在住院期间吞咽困难。AIS 后发生吞咽困难的患者院内死亡率较低（OR 0.61；95%CI：0.60-0.63）或出院回家的可能性较低（AOR 0.51；95%CI：0.51-0.52），住院时间延长（β系数=0.43 天；95%CI：0.36-0.50），住院费用增加（$14411.96；95%CI：13565.68-15257.44）（均 P<0.001）。ICH 后发生吞咽困难的患者院内死亡率较低（AOR 0.39；95%CI：0.37-0.4），出院回家的可能性较低（AOR 0.59，95%CI：0.57-0.61），住院时间延长（β系数=1.99 天；95%CI：1.78-2.21），住院费用增加（$28251.93；95%CI：$25594.57-30909.28）（均 P<0.001）。
这是第一项报告 AIS 和 ICH 后吞咽困难患者全国趋势的研究。这些患者的住院时间更长，出院时的功能结局更差，住院费用更高。
