Trends in Patients with Dysphagia After Intracerebral Hemorrhage: A Propensity Score Matched 20-year Analysis of the National Inpatient Sample

Introduction: Dysphagia is a common symptom of stroke. Intracerebral hemorrhage (ICH) is responsible for 10-15% of all strokes, and less is known about patients with dysphagia following ICH compared to ischemic stroke. The aim of this study was to identify the risk factors for dysphagia following ICH and evaluate in-hospital outcomes in these patients.

Methods: A query of the 2000-2019 National Inpatient Sample was performed for patients admitted with ICH (ICD9 431, 432.9, ICD-10 I61, I62.9). Demographics, comorbidities, and outcomes were identified. 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 used in multivariate regression to generate adjusted odds ratios (AOR)/β-coefficients for the presence of dysphagia on outcomes. Significance set at an alpha level of < 0.001. All analysis performed in R version 4.1.3.

Results: 2,000,868 patients with ICH were identified; 203,511 (10.2%) had in-hospital dysphagia. At baseline, a higher percentage of patients with dysphagia after ICH were male and older, with a greater proportion insured by Medicaid and Medicare (p < 0.001). After propensity matching, smoking history and ventilator use were still significantly different between the two groups (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 (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).

Conclusion : This is the first study to report on national trends in patients with dysphagia after ICH. While in-hospital mortality was lower for patients with dysphagia, hospital costs were much higher and patient outcomes at discharge were worse, suggesting significant functional deficit at discharge.