A. L. Lubitz1, A. P. Johnson3, R. Moon1, T. A. Santora2, A. Pathak2, J. A. Shinefeld2, A. J. Goldberg2, H. A. Pitt2 1Lewis Katz School of Medicine,Department Of Surgery,Philadelphia, PA, USA 2Temple University Health System,Philadelphia, PA, USA 3Sidney Kimmel MEdical College at Thomas Jefferson University,Department Of Surgery,Philadelphia, PA, USA
Introduction: Hospital-acquired aspiration is an uncommon but lethal condition. A recent analysis from our institution suggested that these patients are a diverse group. Common features included advanced age, male gender, multiple comorbidities, neurologic or gastrointestinal disease, altered mental status and prolonged hospitalization. However, data describing characteristics that differentiate hospitalized patients who aspirate from those who do not are limited. Therefore, the aim of this analysis was to determine the risk factors for hospital-acquired aspiration.
Methods: From 2014 to 2016, patients who experienced a significant aspiration event not present on admission were identified from coded Vizient data. Fatal aspiration was confirmed by our 100% mortality review process. A random sample of patients who were admitted within two days of cases with the same distribution of diagnoses were identified as controls. Seventy variables of aspiration and control patients were compared by standard statistics. Variables identified as significant (p<0.05) on univariate analysis were entered into a multivariable regression model to determine the independent risk factors for hospital-acquired aspiration.
Results: Over the study period, 276 aspiration and 307 control patients were identified. Cases and controls were matched for admission diagnosis. Aspiration patients were more likely to die (33 vs 7%, p<0.001), to be admitted to an ICU (99 vs 32%, p<0.001), and to require ventilation (79 vs 22%, p<0.001). Aspiration patients had a longer mean length of stay (23 vs 11 days, p<0.001) and were more likely to be discharged to a skilled nursing facility (27 vs 7%, p< 0.001). On univariate analysis, aspiration patients and controls differed significantly on 35 variables. Multivariable regression identified eight independent variables that remained significant (p<0.01)(Table). Factors that differentiated aspiration patients from controls included age (OR 1.03), prehospital residence (OR 6.95), non-English language (OR 3.74), impaired swallowing (OR 11.0), antidepressant medication (OR 3.11), an operative procedure (OR 11.1), vomiting (OR 6.83) and altered mental status (OR 7.82).
Conclusion: Aspiration is an under recognized hospital-acquired condition which is associated with devastating outcomes. Older patients transferred from other facilities with a language barrier, impaired swallowing, and/or a history of depression are at an increased risk. When these patients undergo a procedure, begin to vomit or develop altered mental status, their risk of aspiration multiplies. Hospital personnel should use this information to identify high-risk patients and implement strategies to prevent hospital-acquired aspiration.
