A. L. Lubitz1, T. A. Santora1, A. Pathak1, J. A. Shinefeld2, A. P. Johnson3, A. J. Goldberg1,2, H. A. Pitt2 1Temple University,Department Of Surgery, Lewis Katz School Of Medicine,Philadelpha, PA, USA 2Temple University,Temple University Health System,Philadelpha, PA, USA 3Thomas Jefferson University,Department Of Surgery, Sidney Kimmel Medical College,Philadelphia, PA, USA
Introduction: Hospital-acquired aspiration is an uncommon, but potentially lethal, condition. A recent retrospective analysis from our institution suggests that patients with fatal aspiration are a diverse group. Some common features include advanced age, male gender, and neurologic impairment. However, the clinically important characteristics of patients who aspirate and are at greatest risk for dying remain elusive. Therefore, the aim of this study was to determine the risk factors for hospital-acquired aspiration-related mortality.
Methods: Over a three-year period from 2014 to 2016, patients who experienced a significant aspiration event, verified with coded Vizient data, were included in the data set. Patients who presented with aspiration on admission were excluded. The 100% mortality review process at our institution was utilized to ascertain whether the aspiration event was a major factor in the patient’s demise. Hospital records were abstracted to determine which patient, clinical, and hospital-related factors led to a significant aspiration. The aspiration patients who died were compared to the aspirators who lived. Variables identified as significant (p<0.07) on univariate analysis were entered into a multivariable regression model to determine the independent risk factors for aspiration-related mortality.
Results:Of the 276 aspiration patients, 92 (33%) died over the three-year study period. For all patients, 74% were 55 years or older; 53% had received anesthesia; 35% had diabetes; 34% were prior non-current smokers; 32% were Caucasian; 20% were considered high risk after a speech and swallow evaluation; 19% had COPD; 18% had impaired gastrointestinal motility; 16% had received anticholinergic medications within 24 hours prior to their event; 14% had a pulmonary diagnosis on admission; and 12% had low magnesium levels (Table). Only 31% of the patients were in an ICU at the time of the aspiration, but 41% were in the hospital for more than a week when the aspiration event occurred. Each of these twelve risk factors were utilized in the multivariable analysis (Table). Independent risk factors for fatal aspiration were prior, non-current smoking (OR= 2.18); impaired gastrointestinal motility (OR= 2.17) and hospitalization greater than 1 week (OR=2.43) (Table).
Conclusion:Fatal aspiration is an under recognized hospital-acquired condition. Patients at greatest risk for dying after an aspiration event are prior non-current smokers, have a diagnosis of impaired gastrointestinal motility and/or a prolonged hospitalization. Hospital personnel should use this information to identify high-risk patients and implement strategies to prevent fatal hospital-acquired aspiration.
