Objective: To characterize inpatient therapy utilization and the impact of aspiration pneumonia (AP) on morbidity, mortality, and outcomes in hospitalized Parkinson’s disease (PD) patients.

Background: PD is one of the world’s fastest growing neurological disorders, with an estimated increase in point prevalence to 1.64 million by 2037. [1,2] When hospitalized, patients with PD often experience preventable complications and underutilization of inpatient therapies (physical therapy (PT), occupational (OT), and speech/swallow therapy (ST)).[3] Aspiration pneumonia (AP) remains a common cause for morbidity and mortality in hospitalized patients with PD.[4] Although studies have investigated AP in hospitalized PD patients, only a few have sufficient sample sizes and geographical diversity to fully appreciate the impact of AP on PD.

Method: We analyzed a de-identified a US based HIPAA-compliant nationwide database of patients (Premier database^TM) with PD hospitalized from 2018-2023. Variables including age, gender, race, length of stay (LOS), admission point of origin, therapeutic interventions and outcomes were analyzed. Cost of care and outcomes for patients with AP were compared to all patients with PD using descriptive statistics.

Results: A total of 501,159 PD patients (60% males) were hospitalized between 2017-2023 with an average LOS of 6.3 days. Across all PD patients, the most prescribed therapy during hospitalization was PT (71%) followed by OT (50%) and ST (31%). The average cost of care during hospitalization was $16,028. In the sample 4.4% expired during the hospitalization and 6% patients were discharged to hospice.

There were 42,035 PD patients (71% males) with a primary or secondary diagnosis of AP. Their average length of stay was 9.6 days (vs 6.3 in patients without AP). ST (69.60%) was the most common therapy prescribed to PD patients with AP. The average cost of care in this sub cohort was $25,199 (vs $16,028 in patients without AP).14.6% patients passed away during the hospitalization (vs 3.5% in patients without AP) and 18.6% (vs 5.3% in patients without AP) patients who were discharged to hospice.

Conclusion: AP increases the length of stay and cost of care as well as morbidity and mortality for hospitalized PD patients. AP also increases the use of ST (70%) in this cohort, though it remains underutilized.

References: 1.Dorsey ER, Sherer T, Okun MS, Bloem BR. The Emerging Evidence of the Parkinson Pandemic. J Parkinsons Dis. 2018;8(s1):S3-S8. doi: 10.3233/JPD-181474. PMID: 30584159; PMCID: PMC6311367.
2. Yang W, Hamilton JL, Kopil C, Beck JC, Tanner CM, Albin RL, Ray Dorsey E, Dahodwala N, Cintina I, Hogan P, Thompson T. Current and projected future economic burden of Parkinson’s disease in the U.S. NPJ Parkinsons Dis. 2020 Jul 9;6:15. doi: 10.1038/s41531-020-0117-1. PMID: 32665974; PMCID: PMC7347582.
3. Aminoff MJ, Christine CW, Friedman JH, Chou KL, Lyons KE, Pahwa R, Bloem BR, Parashos SA, Price CC, Malaty IA, Iansek R, Bodis-Wollner I, Suchowersky O, Oertel WH, Zamudio J, Oberdorf J, Schmidt P, Okun MS; National Parkinson Foundation Working Group on Hospitalization in Parkinson’s Disease. Management of the hospitalized patient with Parkinson’s disease: current state of the field and need for guidelines. Parkinsonism Relat Disord. 2011 Mar;17(3):139-45. doi: 10.1016/j.parkreldis.2010.11.009. Epub 2010 Dec 14. PMID: 21159538; PMCID: PMC3070297.
4. Akbar U, Dham B, He Y, Hack N, Wu S, Troche M, Tighe P, Nelson E, Friedman JH, Okun MS. Incidence and mortality trends of aspiration pneumonia in Parkinson’s disease in the United States, 1979-2010. Parkinsonism Relat Disord. 2015 Sep;21(9):1082-6. doi: 10.1016/j.parkreldis.2015.06.020. Epub 2015 Jul 2. PMID: 26154915.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/morbidity-and-mortality-associated-with-aspiration-pneumonia-nationwide-trends-in-inpatient-therapy-utilization-in-parkinsons-disease-hospitalization/