Tentative nil per os leads to poor outcomes in older adults with aspiration pneumonia.
Patients with aspiration pneumonia (AP) may experience swallowing function declines during treatment, necessitating artificial feeding methods. Proper AP treatment contributes to maintaining activities of daily living. The aim was to assess the effect of tentative nil per os (NPO) status on the recovery of AP patients and declines in their swallowing abilities.



In this retrospective cohort study, 331 patients with AP having oral food intake in premorbid status were included after exclusions for reasons such as vomiting or respiratory insufficiency. We divided subjects into 2 groups: an early oral intake (EOI) group and a tentative NPO group according to the directions by the attending doctors at admission. We created a population model related to groupings from all subjects, which was a homoscedastic model without statistical differences by the inverse probability of treatment weighted (IPTW) method and compared outcomes between the groups.



In the IPTW model, tentative NPO status resulted in poorer nutritional intake every day for 1 week from the date of admission (p < 0.05), a significantly longer treatment duration (50% treatment length: NPO group, 13 days [95% confidence interval (CI), 12.04-13.96] and EOI group, 8 days [95% CI, 7.69-8.31 [log-rank test, p < 0.001]) and greater decline in swallowing ability over the course of treatment (p < 0.001).



Tentative NPO status with AP at hospital admission resulted in adverse effects on patients, including prolonged treatment duration and declines in swallowing ability. Avoiding unnecessary NPO might be another method to treat AP and contribute to the patient's outcomes in addition to medication administration.
Department of Nutrition and Dysphagia Rehabilitation, Tamana Regional Health Medical Center, 2172 Tamana, Tamana City 865-0005, Kumamoto Prefecture, Japan; Division of Swallowing and Nutritional Therapy, Tamana Regional Health Medical Center, 2172 Tamana, Tamana City 865-0005, Kumamoto Prefecture, Japan. Electronic address: maeda4work@tng.bbiq.jp.
Keisuke
K
Maeda
Division of Swallowing and Nutritional Therapy, Tamana Regional Health Medical Center, 2172 Tamana, Tamana City 865-0005, Kumamoto Prefecture, Japan. Electronic address: nutrition1973@yahoo.co.jp.
Takayuki
T
Koga
Department of Surgery, Tamana Regional Health Medical Center, 2172 Tamana, Tamana City 865-0005, Kumamoto Prefecture, Japan. Electronic address: jnjakagi@gmail.com.
Junji
J
Akagi
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000378:metabolism; D003679:Deglutition / Q000502:physiology; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011015:Pneumonia, Aspiration / Q000150:complications / Q000628:therapy*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014839:Vomiting
D002097:C-Reactive Protein
Aspiration pneumonia; Deglutition; Nutritional support; Propensity score; Swallowing disorders