Epidemiology and impact of aspiration pneumonia in patients undergoing surgery in Maryland, 1999-2000.
OBJECTIVE
The epidemiology of aspiration pneumonia and its impact on clinical and economic outcomes in surgical patients are poorly defined. We sought to identify preoperative patient characteristics and surgical procedures that are associated with an increased risk for aspiration pneumonia and to determine the clinical and economic impact in hospitalized surgical patients.


METHODS
Observational study using a state discharge database.


METHODS
All hospitals in Maryland.


METHODS
We obtained discharge data for 318,880 adult surgical patients in 52 Maryland hospitals from January 1, 1999, through December 31, 2000.


RESULTS
The primary outcome variable was a discharge diagnosis of aspiration pneumonia. Unadjusted and adjusted analyses were performed to identify patient characteristics and surgical procedures associated with an increased risk for aspiration pneumonia and to determine the impact on intensive care unit admission, in-hospital mortality, hospital length of stay, and total hospital charges. The overall prevalence of aspiration pneumonia was 0.8%. The prevalence varied among hospitals (range, 0% to 1.9%) and by surgical procedure (range, <0.1% to 19.1%). Patient characteristics independently associated with an increased risk included: male sex, nonwhite race, age of >60 yrs vs. 18-29 yrs, dementia, chronic obstructive pulmonary disease, renal disease, malignancy, moderate to severe liver disease, and emergency room admission. In patients undergoing procedures other than tracheostomy, aspiration pneumonia was independently associated with an increased risk for admission to the intensive care unit (odds ratio, 4.0; 95% confidence interval, 3.0-5.1), in-hospital mortality (odds ratio, 7.6; 95% confidence interval, 6.5-8.9), longer hospital length of stay (estimated mean increase of 9 days; 95% confidence interval, 8-10), and increased total hospital charges (estimated mean increase of 22,000 US dollars; 95% confidence interval, 19,000 US dollars-25,000 US dollars).


CONCLUSIONS
Aspiration pneumonia occurs in approximately 1% of surgical patients and is associated with significant morbidity, mortality, and costs of care. Given that the rate of aspiration pneumonia varies among hospitals, we can improve the quality and reduce the costs of care by implementing strategies to reduce the rate of aspiration pneumonia.
Kozlow
Jeffrey H
JH
Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins University Schools of Medicine and Hygiene and Public Health, Baltimore, MD, USA.
Berenholtz
Sean M
SM
Garrett
Elizabeth
E
Dorman
Todd
T
Pronovost
Peter J
PJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D003422:Critical Care / Q000191:economics / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D017722:Hospital Charges / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000706:statistics & numerical data; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D011015:Pneumonia, Aspiration / Q000191:economics / Q000209:etiology / Q000401:mortality*; D011183:Postoperative Complications / Q000191:economics / Q000209:etiology / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000401:mortality; D016019:Survival Analysis