Implications of postoperative pulmonary aspiration following major urologic surgery. Can J Urol 2018 Feb;25(1):9186-9192
Date
03/12/2018Pubmed ID
29524973Scopus ID
2-s2.0-85043463981 (requires institutional sign-in at Scopus site) 3 CitationsAbstract
INTRODUCTION: The purpose of this article is to assess the incidence of pulmonary aspiration following major urologic surgery, predictors of an aspiration event, and subsequent clinical outcomes.
MATERIALS AND METHODS: The Healthcare Cost and Utilization Project State Inpatient Database for California between 2007-2011 was used to identify cystectomy, prostatectomy, partial and radical nephrectomy patients. Aspiration events were identified within 30 days of surgery. The primary outcome was 30 day mortality and secondary outcomes included total length of stay, discharge location, and diagnoses of acute renal failure, pneumonia or sepsis. Descriptive statistics were performed. A multivariable logistic regression was performed to determine independent predictors of an aspiration event. A separate nonparsimonious logistic regression was fit to determine the independent effect of an aspiration event on 30 day mortality.
RESULTS: Of 84,837 major urologic surgery patients 319 (0.4%) had an aspiration event. Risk factors for aspiration included ileus, congestive heart failure, paraplegia, chronic lung disease, and age = 80 years (all p < 0.01). Aspiration patients had higher rates of renal failure (36.1% versus 2.5%), pneumonia (36.1% versus 2.5%), sepsis (35.7% versus 0.7%), a prolonged length of stay (17 days versus 3 days), and discharge to nursing facility(26.3% vs 2.3%) (all p<0.001). The 30 day mortality rate following aspiration was 20.7% compared to 0.8% (p < 0.001). Aspiration independently increases the risk of 30 day mortality (OR 3.1 (95%CI 2.2-4.5).
CONCLUSIONS: Postoperative aspiration following major urologic surgery is a devastating complication and precautions must be undertaken in high risk patient populations to avoid such an event.
Author List
Kirshenbaum EJ, Blackwell RH, Li B, Kothari AN, Kuo PC, Flanigan RC, Gorbonos A, Gupta GNAuthor
Anai N. Kothari MD Assistant Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AgedAged, 80 and over
Analysis of Variance
Cohort Studies
Cystectomy
Databases, Factual
Disease-Free Survival
Female
Hospital Mortality
Humans
Male
Middle Aged
Multivariate Analysis
Nephrectomy
Pneumonia, Aspiration
Postoperative Complications
Prognosis
Prostatectomy
Retrospective Studies
Risk Assessment
Survival Analysis
Urologic Neoplasms
Urologic Surgical Procedures