Mittal Anmol, Patel Mansi, Wang Daniel, Khrais Ayham, Chyn Eric Tien Yen
Department of Medicine, Rutgers University New Jersey Medical School, Newark, USA.
Department of Geriatrics, Mount Sinai Hospital, New York, USA.
Cureus. 2023 May 19;15(5):e39223. doi: 10.7759/cureus.39223. eCollection 2023 May.
Background Aspiration pneumonia is common in older adults admitted for community-acquired pneumonia and is associated with significant morbidity and mortality. Factors that put this population at higher risk of aspiration include cognitive impairment, neuromuscular dysfunction, and dysphagia. This study aimed to determine whether a concurrent diagnosis of dysphagia conferred a higher risk of complications in the elderly admitted for aspiration pneumonia. Methods The National Inpatient Sample 2001-2013 database was queried for patients, aged 65 or older, with a diagnosis of aspiration pneumonia using International Classification of Diseases, Ninth Revision (ICD-9) codes. Sepsis, respiratory failure, and intubation were identified with their respective ICD-9 codes. A chi-square test and binary logistic regression analysis were used to examine socio-demographic and complication variables, with a significance level of α <0.001. Results A total of 1,097,325 patients were admitted for aspiration pneumonia, of which 349,861 (24.2%) had dysphagia. After incorporating socio-demographic variables, the dysphagia group had a significantly lower likelihood of having sepsis (OR=0.72), respiratory failure (OR=0.92), intubation (OR=0.52), and inpatient mortality (OR = 0.59). Patients with dysphagia had a significantly higher likelihood of increased length of stay (OR=1.24). Conclusions Elderly patients admitted with aspiration pneumonia with a co-diagnosis of dysphagia were less likely to have inpatient morbidity and mortality compared to their counterparts. This may be due to improved speech evaluation and treatment in patients with dysphagia allowing for better control of macro and micro aspiration. Future research is needed to examine if universal speech therapy can reduce hospitalization and long-term mortality for such patients.
吸入性肺炎在因社区获得性肺炎入院的老年人中很常见，且与显著的发病率和死亡率相关。使该人群发生吸入风险更高的因素包括认知障碍、神经肌肉功能障碍和吞咽困难。本研究旨在确定吞咽困难的并存诊断是否会使因吸入性肺炎入院的老年人发生并发症的风险更高。方法：查询2001 - 2013年全国住院患者样本数据库，以获取年龄在65岁及以上、使用国际疾病分类第九版（ICD - 9）编码诊断为吸入性肺炎的患者。通过各自的ICD - 9编码识别脓毒症、呼吸衰竭和插管情况。采用卡方检验和二元逻辑回归分析来检查社会人口统计学和并发症变量，显著性水平为α <0.001。结果：共有1,097,325例患者因吸入性肺炎入院，其中349,861例（24.2%）有吞咽困难。纳入社会人口统计学变量后，吞咽困难组发生脓毒症（OR = 0.72）、呼吸衰竭（OR = 0.92）、插管（OR = 0.52）和住院死亡率（OR = 0.59）的可能性显著更低。有吞咽困难的患者住院时间延长的可能性显著更高（OR = 1.24）。结论：与无吞咽困难的患者相比，因吸入性肺炎入院且并存吞咽困难诊断的老年患者发生住院并发症和死亡的可能性更低。这可能是由于吞咽困难患者的言语评估和治疗得到改善，从而能更好地控制宏观和微观吸入。未来需要进行研究，以检验通用言语治疗是否能降低此类患者的住院率和长期死亡率。
