Dysphagia-associated inpatient risk phenotypes and mortality in hospitalized head and neck cancer: A national analysis.

Abstract

11085 Background: Dysphagia is common in patients with head and neck cancer (HNC) but is often viewed as a quality-of-life issue rather than a driver of acute inpatient outcomes. Its contribution to airway failure, mortality, and resource utilization is poorly defined, particularly when dysphagia is uncoded. We evaluated whether dysphagia-associated clinical signals define inpatient risk phenotypes, including a high-risk subgroup with silent dysphagia. Methods: We conducted a survey-weighted analysis of the National Inpatient Sample (NIS), 2016 to 2023, including adults hospitalized with HNC identified using ICD-10-CM codes C00 to C14 and C30 to C32. Tumors were categorized by first-hit anatomic site, and palliative admissions (Z51.5) were excluded. Dysphagia-associated signals included dysphagia (R13*), aspiration pneumonia (J69*), and feeding tube placement (ICD-10-PCS 0DH6*), which were combined into mutually exclusive dysphagia phenotypes. Silent dysphagia was defined as aspiration pneumonia or feeding tube placement without dysphagia coding. The primary outcome was in-hospital mortality. Secondary outcomes included mechanical ventilation, tracheostomy, shock, length of stay (LOS), and hospitalization cost. Survey-weighted regression models adjusted for demographics, payer, socioeconomic status, admission characteristics, hospital factors, tumor site, comorbidity burden, and year. Results: Among 112,495 unweighted HNC hospitalizations (weighted national estimate approximately 562,000), 26.6% had coded dysphagia, 8.7% aspiration pneumonia, and 16.3% underwent feeding tube placement; 11.4% met criteria for silent dysphagia. Mortality increased stepwise across phenotypes, from 1.82% (95% CI 1.72 to 1.93) in patients without dysphagia-associated signals to 8.59% (95% CI 7.80 to 9.47) with aspiration alone. Aspiration plus feeding tube placement was associated with the longest LOS (20.2 days, 95% CI 18.9 to 21.6) and highest mean cost ($77,615, 95% CI $70,531 to $84,700). In adjusted analyses, aspiration alone was associated with higher mortality (OR 3.77, 95% CI 3.26 to 4.36), as was aspiration with feeding tube placement (OR 2.40, 95% CI 1.70 to 3.40). Dysphagia coding alone was not associated with increased mortality (OR 0.71, 95% CI 0.60 to 0.83). Silent dysphagia was independently associated with mortality (OR 2.31, 95% CI 2.04 to 2.61), mechanical ventilation (OR 3.77, 95% CI 3.51 to 4.03), and tracheostomy (OR 4.69, 95% CI 4.40 to 4.99). Conclusions: Dysphagia-associated clinical signals define inpatient risk phenotypes in hospitalized patients with HNC. While dysphagia coding alone does not confer excess mortality risk, aspiration pneumonia and feeding tube placement when dysphagia is uncoded identify a high-risk population with increased mortality, airway failure, LOS, and cost, supporting earlier inpatient recognition and intervention.