Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Canada.
Biostatistics (Canada) Global Database Studies, IQVIA, Mississauga, Canada.
J Otolaryngol Head Neck Surg. 2023 Mar 7;52(1):23. doi: 10.1186/s40463-022-00617-2.
Aspiration pneumonia is a preventable condition that has higher rates of recurrence and mortality compared to non-aspiration pneumonia. The primary objective of the study was to examine independent patient factors that are associated with mortality in those requiring acute admission for aspiration pneumonia at a tertiary institution. Secondary goals of the study were to review whether factors such as mechanical ventilation and speech language pathology intervention can impact patient mortality, length of stay (LOS), and costs relating to hospitalization.
Patients older than 18 years of age who were admitted with a primary diagnosis of aspiration pneumonia from January 1, 2008 to December 31, 2018 at Unity Health Toronto-St. Michael's hospital in Toronto, Canada, were included in the study. Descriptive analyses were performed on patient characteristics using age as a continuous variable as well as a dichotomous variable with age 65 as a cut-off. Multivariable logistic regression was used to identify independent factors that contributed to in-hospital mortality and Cox proportional-hazard regression was used to identify independent factors that affected LOS.
A total of 634 patients were included in this study. 134 (21.1%) patients died during hospitalization with an average age of 80.3 ± 13.4. The in-hospital mortality did not change significantly over the ten-year period (p = 0.718). Patients who died had longer LOS with a median length of 10.5 days (p = 0.012). Age [Odds Ratio (OR) 1.72, 95% Confidence Interval (95% CI) 1.47-2.02, p < 0.05] and invasive mechanical ventilation (OR 2.57, 95% CI 1.54-4.31, p < 0.05) were independent predictors of mortality while female gender was found to be a protective factor (OR 0.60, 95% CI 0.38-0.92, p = 0.02). Elderly patients had five times higher risk of dying during their hospital course when compared to younger patients [Hazard Ratio (HR) 5.25, 95% CI 2.99-9.23, p < 0.05).
Elderly patients are a high-risk population for developing aspiration pneumonia and are at higher risk of death when hospitalized for this condition. This warrants improved preventative strategies in the community. Further studies involving other institutions and creating a Canada-wide database are required.
与非吸入性肺炎相比，吸入性肺炎是一种可预防的疾病，但复发率和死亡率更高。本研究的主要目的是研究与在三级医疗机构因吸入性肺炎急性入院的患者死亡率相关的独立患者因素。本研究的次要目标是评估诸如机械通气和言语病理学干预等因素是否会影响患者死亡率、住院时间（LOS）以及与住院相关的费用。
纳入 2008 年 1 月 1 日至 2018 年 12 月 31 日期间在加拿大多伦多 Unity Health Toronto-St. Michael's 医院因原发性吸入性肺炎入院且年龄大于 18 岁的患者。使用年龄作为连续变量和年龄 65 岁作为截定点对患者特征进行描述性分析。多变量逻辑回归用于确定与院内死亡率相关的独立因素，Cox 比例风险回归用于确定影响 LOS 的独立因素。
本研究共纳入 634 例患者。134 例（21.1%）患者在住院期间死亡，平均年龄为 80.3±13.4 岁。在十年期间，院内死亡率无显著变化（p=0.718）。死亡患者的 LOS 更长，中位数为 10.5 天（p=0.012）。年龄[比值比（OR）1.72，95%置信区间（95%CI）1.47-2.02，p<0.05]和有创机械通气（OR 2.57，95%CI 1.54-4.31，p<0.05）是死亡率的独立预测因素，而女性是保护因素（OR 0.60，95%CI 0.38-0.92，p=0.02）。与年轻患者相比，老年患者在住院期间死亡的风险高五倍[风险比（HR）5.25，95%CI 2.99-9.23，p<0.05]。
老年患者是发生吸入性肺炎的高危人群，因该病住院的死亡风险更高。这需要在社区中制定更好的预防策略。需要进一步研究涉及其他机构并创建一个全加数据库。
