Introduction: Cervical spine injuries (CSI) may be complicated by dysphagia in hospitalized patients. We sought to describe the incidence and identify risk-factors associated with dysphagia among CSI patients.
Methods: Data was obtained from 2003-2010 Nationwide Inpatient Sample. Adults (>18years) with CSI (ICD9codes: 805.xx-806xx) were included. Individuals who developed dysphagia (ICD9code: 787.2x-x) and/or underwent cervical spine fusion surgery (CSFS) (ICD9codes: 81.01-81.03) were identified. Multivariate logistic regression assessed factors associated with developing dysphagia.
Results: In all, 384,174 patients were admitted with CSI, 3.27% of whom developed complications of dysphagia. Most were male (61.07%); gender distribution did not differ significantly between dysphagia versus non-dysphagia patients (p=0.351). Dysphagia patients were mostly aged >/=65years (62.52%) with mean age of 66.97years (SE=0.45), and treated at teaching hospitals (69.24%). Overall, 17.33% of patients underwent CSFS. Dysphagia occurred in 5.56% of patients that underwent CSFS versus 2.79% without CSFS (p<0.001). Multivariate analysis revealed higher likelihood for dysphagia among patients >/=65 years (OR2.20; 95%CI=1.94-2.51), males (OR1.17; 95%CI=1.07-1.27), individuals with associated spinal cord injury (OR1.29; 95%CI=1.15-1.45), patients that underwent CSFS (OR1.69; 95%CI=1.41-2.03), and patients with medical comorbidities including stroke (OR1.76; 95%CI=1.52-2.04), peptic ulcer disease (OR2.03; 95%CI=1.39-2.97), cancer (OR1.77; 95%CI=1.51-2.05), dementia (OR1.75; 95%CI=1.28-2.40), hemiplegia/paraplegia (OR3.29; 95%CI=2.61-4.16), and chronic obstructive pulmonary disease (OR1.15; 95%CI=1.02-1.31). Patients that underwent anterior-CSFS versus posterior-CSFS (OR2.38; 95%CI=2.03-2.79), and CSFS involving multiple spine segments [2-3 segments (OR1.37; 95%CI=1.30-1.66) and 4-8 segments (OR1.30; 95%CI=1.04-1.63)] were at increased risk of dysphagia. Inpatient mortality in dysphagia versus non-dysphagia (6.58% vs. 6.91%, p=0.53). Dysphagia patients were more likely for prolonged hospitalization (16 vs. 9 days, p<0.001). Average total incremental charges associated with dysphagia per individual were $50,168, amounting in additional charges in CSI management totaling nearly $80 million annually.
Conclusions: Dysphagia in CSI is associated with increased morbidity, prolonged hospitalization, and increased hospitalization costs. At-risk patients need to be identified, in order to minimize adverse outcomes.
Patient Care: This research will provide information on predisposing risk factors for dysphagia in patients with cervical spine injury, and will help in risk stratification with the goal of minimizing complications and improving overall outcome.
Learning Objectives: 1. To describe the risk factors associated with the development of dysphagia among patients with acute cervical spine injury.
2. To describe outcomes in adult patients developing dysphagia after cervical spine injury.