Aspiration pneumonia is an independent risk factor associated with long-term hospital stay: a prospective cohort study

Abstract

AbstractBackgroundLong-term hospital stay is associated with functional decline in patients with pneumonia especially in the elderly. Among elderly patients with pneumonia, aspiration pneumonia is a major disease category. It is still not clear whether long-term hospital stay is due to aspiration pneumonia itself caused by underlying oropharyngeal dysfunction or simply due to functional decline in elderly patients with multiple comorbidities during acute infection. The observational study aim is to identify whether aspiration pneumonia itself was associated with long-term hospital stay.MethodsA prospective observational study focused on community-acquired or healthcare-associated pneumonia (HCAP) was carried out from January 2012 through January 2014. Patients at risk for aspiration pneumonia were identified as those who experienced documented episodes of aspiration, chronic disturbances of consciousness and/or chronic neuromuscular diseases. We defined thirty-day hospital stay as long-term hospital stay and compared thirty-day hospital stay between aspiration pneumonia group and the other pneumonia group with logistic regression analysis. Potential confounding factors included age, gender, diagnosis of HCAP, CURB criteria, body mass index, long-term bed-ridden state, heart failure, cerebrovascular disorders, dementia, use of antipsychotics, and use of hypnotics. In a sub-analysis, we also explored factors associated with long-term hospital stay in patients with aspiration pneumonia.ResultsOur study enrolled 2,795 patients; 878 (31.4%) were at risk for developing aspiration pneumonia. After adjusting potential confounders, the aspiration pneumonia is a risk factor of long-term hospital stay (adjusted odds ratio 1.43; 95% confidence interval 1.09 - 1.88, p <0.01). Higher age, male gender, high CURB score, diagnosis of HCAP, low BMI, heart failure, cerebrovascular disease and use of antipsychotics were suggested to be the risk of long-term hospital stay. Sub-analysis revealed factors associated with long-term hospital stay in aspiration pneumonia group that included higher age, male gender, high CURB score, multi-lobar chest X-ray involvement and use of antipsychotic drugs.ConclusionsAspiration pneumonia itself was independently associated with long-term hospital stay. This result can lead to move specific rehabilitation strategies for pneumonia patients with underlying oropharyngeal dysfunction.