Rosemary Nustas, MD, Raj M. Dalsania, MD, Jason M. Brown, MD, Srikrishna Patnana, MBBS, MPH, Emad S. Qayed, MD, MPH; Emory University School of Medicine, Atlanta, GA
Introduction: Dysphagia is a common symptom in patients hospitalized with human immunodeficiency virus (HIV). There are limited data on the relationship between dysphagia and important hospital outcomes. The aim of this study is to assess the impact of dysphagia on hospital costs, length of stay, mortality, and 30-day readmission rates in HIV patients hospitalized with dysphagia. Methods: We used the Nationwide Readmissions Database (NRD) to identify all adult hospitalizations with HIV between January 2010 to September 2015. We stratified cases according to the presence of dysphagia (ICD-9-CM 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 length of stay, 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 length of stay (12 vs 7.4 days; P < 0.0001), higher hospitalization cost ($32993 vs $21813, 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). Discussion: In hospitalized patients with HIV, dysphagia is a significant independent predictor of longer lengths of stay, 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.
Table 1. Characteristics of HIV admissions with or without dysphagia (n = 206332), Nationwide Readmission Database, 2010-2015.
Table 2: Comparison of hospitalization costs, length of stay, mortality and readmission rates in HIV patients with and without dysphagia
Disclosures: Rosemary Nustas indicated no relevant financial relationships. Raj Dalsania indicated no relevant financial relationships. Jason Brown indicated no relevant financial relationships. Srikrishna Patnana indicated no relevant financial relationships. Emad Qayed indicated no relevant financial relationships.