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Epidemiology and impact of aspiration pneumonia in patients undergoing surgery in Maryland, 1999-2000.
Crit Care Med. 2003 Jul; 31(7):1930-7.CC

Abstract

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.

DESIGN

Observational study using a state discharge database.

SETTING

All hospitals in Maryland.

PATIENTS

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

MEASUREMENTS AND MAIN 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.

Authors+Show Affiliations

Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins University Schools of Medicine and Hygiene and Public Health, Baltimore, MD, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12847385

Citation

Kozlow, Jeffrey H., et al. "Epidemiology and Impact of Aspiration Pneumonia in Patients Undergoing Surgery in Maryland, 1999-2000." Critical Care Medicine, vol. 31, no. 7, 2003, pp. 1930-7.
Kozlow JH, Berenholtz SM, Garrett E, et al. Epidemiology and impact of aspiration pneumonia in patients undergoing surgery in Maryland, 1999-2000. Crit Care Med. 2003;31(7):1930-7.
Kozlow, J. H., Berenholtz, S. M., Garrett, E., Dorman, T., & Pronovost, P. J. (2003). Epidemiology and impact of aspiration pneumonia in patients undergoing surgery in Maryland, 1999-2000. Critical Care Medicine, 31(7), 1930-7.
Kozlow JH, et al. Epidemiology and Impact of Aspiration Pneumonia in Patients Undergoing Surgery in Maryland, 1999-2000. Crit Care Med. 2003;31(7):1930-7. PubMed PMID: 12847385.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Epidemiology and impact of aspiration pneumonia in patients undergoing surgery in Maryland, 1999-2000. AU - Kozlow,Jeffrey H, AU - Berenholtz,Sean M, AU - Garrett,Elizabeth, AU - Dorman,Todd, AU - Pronovost,Peter J, PY - 2003/7/9/pubmed PY - 2003/8/13/medline PY - 2003/7/9/entrez SP - 1930 EP - 7 JF - Critical care medicine JO - Crit Care Med VL - 31 IS - 7 N2 - 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. DESIGN: Observational study using a state discharge database. SETTING: All hospitals in Maryland. PATIENTS: We obtained discharge data for 318,880 adult surgical patients in 52 Maryland hospitals from January 1, 1999, through December 31, 2000. MEASUREMENTS AND MAIN 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. SN - 0090-3493 UR - https://www.unboundmedicine.com/medline/citation/12847385/Epidemiology_and_impact_of_aspiration_pneumonia_in_patients_undergoing_surgery_in_Maryland_1999_2000_ DB - PRIME DP - Unbound Medicine ER -