Hospital Medicine Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Clin Interv Aging. 2024 Aug 22;19:1461-1470. doi: 10.2147/CIA.S474569. eCollection 2024.
Older patients have a higher risk of aspiration pneumonia and mortality if they are hospitalized. We aimed to assess the effectiveness of an aspiration prevention quality improvement (QI) program that utilizes the Gugging Swallowing Screen (GUSS) in older patients.
This retrospective cohort study was conducted in an acute medical care unit of a tertiary hospital in South Korea. The study used one-to-one propensity matching and included 96 patients who received the QI program and 96 who did not. All patients were aged 65 years or older and had risk factors for aspiration, including neurological and non-neurological disorders, neuromuscular disorders, impaired airway defenses, and dysphagia due to esophageal or gastrointestinal disorders. The primary outcomes included the duration of the fasting period during hospitalization, changes in nutritional status before admission and at discharge, in-hospital mortality, and readmission due to pneumonia within 90 days.
Fasting period, changes in weight and albumin levels upon discharge after hospitalization, and length of stay did not differ significantly between patients in the GUSS and non-GUSS groups. However, the risk of readmission within 90 days was significantly lower in patients who underwent the GUSS than in those who did not (hazard ratio, 0.085; 95% confidence interval, 0.025-0.290; p = 0.001).
The GUSS aspiration prevention program effectively prevented readmission due to pneumonia within 90 days in older patients with acute illnesses. This implies that the adoption of efficient aspiration prevention methods in older patients with acute illnesses could play a pivotal role by enhancing patient outcomes and potentially mitigating the healthcare costs linked to readmissions.
老年人住院时发生吸入性肺炎和死亡的风险更高。本研究旨在评估使用 Gugging 吞咽筛查（GUSS）预防吸入的质量改进（QI）计划对老年患者的有效性。
这是一项在韩国一家三级医院急性医疗护理病房进行的回顾性队列研究。该研究采用一对一倾向评分匹配，纳入了 96 例接受 QI 计划的患者和 96 例未接受 QI 计划的患者。所有患者年龄均在 65 岁及以上，且存在吸入风险因素，包括神经和非神经疾病、神经肌肉疾病、气道防御受损以及食管或胃肠道疾病引起的吞咽困难。主要结局包括住院期间禁食时间、入院前和出院时营养状况的变化、住院期间死亡率以及 90 天内因肺炎再入院。
GUSS 组和非 GUSS 组患者的禁食时间、住院后出院时体重和白蛋白水平的变化以及住院时间无显著差异。然而，GUSS 组患者 90 天内再入院的风险显著低于非 GUSS 组（风险比，0.085；95%置信区间，0.025-0.290；p = 0.001）。
GUSS 吸入预防计划可有效预防急性疾病老年患者 90 天内因肺炎再入院。这意味着在急性疾病老年患者中采用有效的吸入预防方法可能通过改善患者结局并可能减轻再入院相关的医疗费用发挥关键作用。
