Healthcare costs of post‐stroke oropharyngeal dysphagia and its complications: malnutrition and respiratory infections

Marín, Sergio; Serra‐Prat, Mateu; Ortega, Omar; Fericgla, Monica Audouard; Valls, Jordi Castellví; Palomera, Elísabet; Cunillera, Ramon; Palomeras, Ernest; Ibàñez, Josep Maria; Clavé, Père

doi:10.1111/ene.14998

Cited by 37 publications

(30 citation statements)

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“…In addition to its clinical impact, post-stroke OD and its main complications, malnutrition and pneumonia, have been associated with independent direct sanitary costs during acute hospitalisation and at long-term follow-up phases, direct non-sanitary costs and indirect costs associated with patient productivity losses [ 4 ]. Some health economic data on the cost and on sanitary resource consumption of post-stroke OD and its main complications have also been reported [ 5 , 6 , 22 ]. However, there is a lack of literature on the cost-effectiveness of the appropriate management of OD.…”

Section: Discussionmentioning

confidence: 99%

“…We believe that these two strong tendencies and the results of new randomised control trials will induce, in the near future, many changes in the management of post-stroke OD and future treatment of stroke will be very different from what it is today. With regard to management, there is evidence to show that increasing the levels of viscosity reduces the risk of airway penetration and aspiration and recent studies with gum-based thickeners show the specific range of viscosity values providing this therapeutic effect on safety of swallow [ 6 ]. Long-term studies showing the clinical impact of fluid thickening in post-stroke patients are clearly required.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with OD incurred higher total hospitalisation costs (€5,357.67 ± €3,391.62 vs. €3,976.30 ± €1,992.58, p < 0.0001), 3-month costs (€8,242.0 ± €5,376.0 vs. €5,320.0 ± €4,053.0, p < 0.0001), and 12-month costs (€11,617.58 ± €12,033.58 vs. €7,242.78 ± €7,402.55, p < 0.0001). Patients with OD who were at risk of malnutrition or malnourished and suffered at least one episode of respiratory infection incurred higher mean costs at 12-months’ follow-up compared with patients who did not developed OD (€19,817.58 ±€13,724.83 vs. €7242.8 ± €7402.6, p < 0.0004) [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Economic evaluations of health care interventions in oropharyngeal dysphagia after stroke: protocol for a systematic review

et al. 2022

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Background and purpose Oropharyngeal dysphagia (OD) affects 40–81% of patients after stroke. A recent systematic review on the costs of OD and its main complications showed higher acute and long-term costs for those patients who developed OD, malnutrition and pneumonia after stroke. These results suggest that appropriate management of post-stroke OD could reduce clinical complications and costs. The purpose of this systematic review is to assess the available literature for healthcare interventions that are efficient or cost-effective in the management of OD. Methods A systematic review on economic evaluations of health care interventions will be performed on post-stroke patients with OD following PRISMA recommendations. Four bibliographic databases will be searched and a subsequent reference check will be done. English and Spanish literature will be included without date restrictions. Studies will be included if they refer to economic evaluations or in which cost savings were reported in post-stroke patients suffering OD. Studies will be excluded if they are partial economic evaluation studies, if they refer to esophageal dysphagia, or if OD is caused by causes different from stroke. Evidence will be presented and synthetised with a narrative method and using tables. Quality evaluation will be done using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. Discussion The protocol for this systematic review is the first step to assess the cost-effectiveness of the healthcare interventions that have been described as potential treatments for post-stroke OD. This systematic review will summarise the current evidence on the relation between cost and benefits associated with the appropriate management of OD in post-stroke patients. Trial registration PROSPERO CRD42020136245

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Economic evaluations of health care interventions in oropharyngeal dysphagia after stroke: protocol for a systematic review

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“…In the article by Marin et al [1], one of the funder details was previously missing on page 3670. The complete funding information should read:…”

Section: Funding Informationmentioning

confidence: 99%

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2022

Euro J of Neurology

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“…Stroke is the second cause of death in the world [ 1 ] and is also a leading cause of disability, which is expected to increase in the coming decades [ 2 ] with high socioeconomic costs [ 3 , 4 ]. Oropharyngeal dysphagia (OD) is one of the most important causes of disability and mortality in patients who have suffered a stroke [ 1 , 2 , 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Spontaneous Swallowing Frequency in Post-Stroke Patients with and Without Oropharyngeal Dysphagia: An Observational Study

et al. 2022

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Oropharyngeal dysphagia (OD) is a frequent complication after stroke (PSOD) that increases morbidity and mortality. Early detection of PSOD is essential to reduce morbidity and mortality in patients with acute stroke. In recent years, an association between reduced spontaneous swallowing frequency (SSF) and OD has been described. Likewise, the reduction of saliva substance P (SP) concentration has been associated with an increased risk of aspiration and a decrease in SSF. In this study we aimed to compare SSF, salivary SP concentration, hydration and nutritional status in post-stroke (PS) patients with and without OD. We included 45 acute PS patients (4.98 ± 2.80 days from stroke onset, 62.22% men, 71.78 ± 13.46 year). The Volume-Viscosity Swallowing Test (V-VST) was performed for clinical diagnosis of OD. SSF/minute was assessed through 10-min neurophysiological surface recordings including suprahyoid-electromyography and cricothyroid-accelerometry. Saliva samples were collected with a Salivette® to determine SP by ELISA. Hydration status was assessed by bioimpedance. Nutritional status was evaluated by Mini Nutritional Assessment Short Form (MNA-sf) and blood analysis. Twenty-seven PS patients (60%) had OD; 19 (40%), impaired safety of swallow. SSF was significantly reduced in PSOD, 0.23 ± 0.18 and PSOD with impaired safety, 0.22 ± 0.18 vs 0.48 ± 0.29 swallows/minute in PS without OD (PSnOD); (both p < 0.005). Nutritional risk was observed in 62.92% PSOD vs 11.11% PSnOD (p = 0.007) and visceral protein markers were also significantly reduced in PSOD (p < 0.05). Bioimpedance showed intracellular dehydration in 37.50% PSOD vs none in PSnOD. There were no differences for saliva SP concentrations. SSF is significantly reduced in PSOD in comparison with PSnOD. Acute PSOD patients present poor nutritional status, hydropenia, and high risk for respiratory complications.

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Healthcare costs of post‐stroke oropharyngeal dysphagia and its complications: malnutrition and respiratory infections

Cited by 37 publications

References 32 publications

Economic evaluations of health care interventions in oropharyngeal dysphagia after stroke: protocol for a systematic review

Economic evaluations of health care interventions in oropharyngeal dysphagia after stroke: protocol for a systematic review

Corrigendum

Spontaneous Swallowing Frequency in Post-Stroke Patients with and Without Oropharyngeal Dysphagia: An Observational Study

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