Dysphagia-related acute stroke complications: A retrospective observational cohort study

Verity E. Bond, Sebastian Doeltgen, Timothy Kleinig, Joanne Murray

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)
65 Downloads (Pure)

Abstract

Objectives: Post-stroke dysphagia is associated with aspiration pneumonia, but strategies intended to mitigate this complication, such as oral intake modifications, may unintentionally lead to dehydration-related complications such as urinary tract infections (UTIs) and constipation. This study aimed to determine the rates of aspiration pneumonia, dehydration, UTI and constipation in a large cohort of acute stroke patients and the independent predictors of each complication. 

Materials and methods: Data were extracted retrospectively for 31,953 acute stroke patients admitted to six hospitals in Adelaide, South Australia over a 20-year period. Tests of difference compared rates of complications between patients with and without dysphagia. Multiple logistic regression modelling explored variables that significantly predicted each complication. 

Results: In this consecutive cohort of acute stroke patients, with a mean (SD) age of 73.8 (13.8) years and 70.2% presenting with ischaemic stroke, rates of complications were: aspiration pneumonia (6.5%); dehydration (6.7%); UTI (10.1%); and constipation (4.4%). Each complication was significantly more prevalent for patients with dysphagia compared to those without. Controlling for demographic and other clinical variables, the presence of dysphagia independently predicted aspiration pneumonia (OR=2.61, 95% CI 2.21-3.07; p<.001), dehydration (OR=2.05, 95% CI 1.76-2.38; p<.001), UTI (OR=1.34, 95% CI 1.16-1.56; p<.001), and constipation (OR=1.30, 95% CI 1.07-1.59; p=.009). Additional predictive factors were increased age and prolonged hospitalisation. 

Conclusions: Aspiration pneumonia, dehydration, UTI, and constipation are common acute sequelae of stroke and independently associated with dysphagia. Future dysphagia intervention initiatives may utilise these reported complication rates to evaluate their impact on all four adverse health complications.

Original languageEnglish
Article number107123
Number of pages8
JournalJournal of Stroke and Cerebrovascular Diseases
Volume32
Issue number6
Early online date12 Apr 2023
DOIs
Publication statusPublished - Jun 2023

Keywords

  • Aspiration pneumonia
  • Cohort study
  • Constipation
  • Dehydration
  • Dysphagia
  • Hemiparesis
  • Stroke
  • Urinary tract infection

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