The effect of compliance on clinical outcomes for patients with dysphagia on videofluoroscopy

This study investigates clinical outcomes and the degree of compliance in p atients who received advice on dysphagia management and the effect of the l evel of compliance on the incidence of chest infections and aspiration pneu monia, cause of death, and hospital readmission. We performed a retrospecti ve cohort study of 140 patients who had video-fluoroscopic studies at Princ ess Margaret Hospital, Christchurch, New Zealand, from 1 January 1996 to 30 June 1997. The degree to which recommendations on dysphagia management wer e followed was correlated with the incidence of chest infections, aspiratio n pneumonia, and readmissions to the hospital. Cause of death, including th e contribution of aspiration pneumonia, was assessed by review of medical r ecords and death certificates. Information was available for 89% of the coh ort. Twenty-one percent of the survivors never complied with the advice giv en. Noncompliant subjects were younger (p < 0.05) and more likely to be liv ing at home rather than receiving institutional care (p = 0.05). Noncomplie rs had more hospital admissions because of chest infections or aspiration p neumonia (22% vs. 1.5%; p < 0.001). Home-dwelling noncompliant subjects rec eived more courses of antibiotics (p < 0.02), but there was no difference i n the number of chest infections. Fifty-four people died during the study p eriod. Aspiration pneumonia was recorded as a definite or probable cause of death in 26 (52%) of the 50 subjects for whom reliable information was ava ilable and in 6 of 7 subjects who made a deliberate and documented decision not to comply. We conclude that noncompliance with recommendations about d ysphagia management is associated with adverse outcomes. There was a high m ortality rate and aspiration pneumonia was a common cause of death.