Characteristics of aspiration pneumonia patients in acute care hospitals: A multicenter, retrospective survey in Northern Japan

Abstract

Background: Pneumonia is a common cause of illness and death of the elderly in Japan. Its prevalence is escalating globally with the aging of population. To describe the latest trends in pneumonia hospitalizations, especially aspiration pneumonia (AP) cases, we assessed the clinical records of pneumonia patients admitted to core acute care hospitals in Miyagi prefecture, Japan.

Methods: A retrospective multi-institutional joint research was conducted for hospitalized pneumonia patients aged ≥20 years from January 2019 to December 2019. Clinical data of patients were collected from the medical records of eight acute care hospitals.

Results: Out of the 1,800 patients included in this study, 79% of the hospitalized pneumonia patients were aged above 70 years. The most common age group was in the 80s. The ratio of AP to total pneumonia cases increased with age, and 692 out of 1,800 patients had AP. In univariate analysis, these patients had significantly older ages, lower body mass index (BMI), a lower ratio of normal diet intake and homestay before hospitalization, along with more AP recurrences and comorbidities. During hospitalization, AP patients had extended fasting periods, more swallowing assessments and interventions, longer hospitalization, and higher in-hospital mortality rate than non-AP patients. A total of 7% and 2% AP patients underwent video endoscopy and video fluorography respectively. In multivariate analysis, lower BMI, lower C-reactive protein, a lower ratio of homestay before hospitalization, a higher complication rate of cerebrovascular disease, dementia, and neuromuscular disease were noted as a characteristic of AP patients. Swallowing interventions were performed for 51% of the AP patients who had been hospitalized for more than two weeks. In univariate analysis, swallowing intervention improved in-hospital mortality. Lower AP recurrence before hospitalization and a lower ratio of homestay before hospitalization were indicated as characteristics of AP patients of the swallowing intervention group from multivariate analysis. Change in dietary pattern from normal to modified diet was observed more frequently in the swallowing intervention group.

Conclusion: AP accounts for 38.4% of all pneumonia cases in acute care hospitals in Northern Japan. The use of swallowing evaluations and interventions, which may reduce the risk of dysphagia and may associate with lowering mortality in AP patients, is still not widespread.

Fig 1. Localization of participating hospitals in Miyagi prefecture, Japan.

A: a map of Japan. B: a map of Miyagi Prefecture. (1) South Miyagi Medical Center, (2) Tohoku University Hospital, (3) Tohoku Rosai Hospital, (4) Sendai City Hospital, (5) Sendai Medical Center, (6) Tohoku Medical and Pharmaceutical University Hospital, (7) Osaki Citizen Hospital, (8) Japanese Red Cross Ishinomaki Hospital. A: Sennan area, B: Sendai area, C: Osaki/Kurihara area, D: Ishinomaki/Tome/Kesennuma area.

Fig 2. A flow chart of patients evaluated throughout the course of this study.

Fig 3. The ratio of aspiration pneumonia to total pneumonia cases.

A: The number of hospitalized aspiration and non-aspiration pneumonia patients according to age. B: The percentages of aspiration and non-aspiration pneumonia patients in total hospitalized pneumonia patients according to age.