Kozlow Jeffrey H, Berenholtz Sean M, Garrett Elizabeth, Dorman Todd, Pronovost Peter J
Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins University Schools of Medicine and Hygiene and Public Health, Baltimore, MD, USA.
Crit Care Med. 2003 Jul;31(7):1930-7. doi: 10.1097/01.CCM.0000069738.73602.5F.
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.
Observational study using a state discharge database.
All hospitals in Maryland.
We obtained discharge data for 318,880 adult surgical patients in 52 Maryland hospitals from January 1, 1999, through December 31, 2000.
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).
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.
吸入性肺炎的流行病学及其对外科患者临床和经济结局的影响尚不清楚。我们试图确定与吸入性肺炎风险增加相关的术前患者特征和手术操作，并确定其对住院外科患者的临床和经济影响。
使用州出院数据库进行的观察性研究。
马里兰州的所有医院。
我们获取了1999年1月1日至2000年12月31日期间马里兰州52家医院318,880例成年外科患者的出院数据。
主要结局变量为吸入性肺炎的出院诊断。进行了未校正和校正分析，以确定与吸入性肺炎风险增加相关的患者特征和手术操作，并确定其对重症监护病房入住、院内死亡率、住院时间和总住院费用的影响。吸入性肺炎的总体患病率为0.8%。患病率在不同医院之间有所不同（范围为0%至1.9%），并因手术操作而异（范围为<0.1%至19.1%）。与风险增加独立相关的患者特征包括：男性、非白人种族、年龄>60岁与18至29岁相比、痴呆、慢性阻塞性肺疾病、肾病、恶性肿瘤、中度至重度肝病以及急诊入院。在接受气管切开术以外手术的患者中，吸入性肺炎与重症监护病房入住风险增加（比值比，4.0；95%置信区间，3.0 - 5.1）、院内死亡率（比值比，7.6；95%置信区间，6.5 - 8.9）、住院时间延长（估计平均增加9天；95%置信区间，8 - 10）以及总住院费用增加（估计平均增加22,000美元；95%置信区间，19,000美元 - 25,000美元）独立相关。
吸入性肺炎发生在约1%的外科患者中，与显著的发病率、死亡率及护理成本相关。鉴于不同医院的吸入性肺炎发生率不同，我们可以通过实施降低吸入性肺炎发生率的策略来提高护理质量并降低护理成本。
