TY - JOUR
T1 - Predictors of Aspiration Pneumonia and Mortality in Patients with Dysphagia
AU - Nativ-Zeltzer, Nogah
AU - Nachalon, Yuval
AU - Kaufman, Matthew W.
AU - Seeni, Indulaxmi C.
AU - Bastea, Silvia
AU - Aulakh, Sukhkaran S.
AU - Makkiyah, Sara
AU - Wilson, Machelle D.
AU - Evangelista, Lisa
AU - Kuhn, Maggie A.
AU - Sahin, Mustafa
AU - Belafsky, Peter C.
N1 - Publisher Copyright: © 2021 The American Laryngological, Rhinological and Otological Society, Inc.
PY - 2022/6
Y1 - 2022/6
N2 - Objectives/Hypothesis: To identify risk factors for pneumonia incidence in patients with dysphagia undergoing a videofluoroscopic swallow study (VFSS) in an outpatient tertiary-care center. Study Design: Historical cohort study. Methods: All individuals undergoing a VFSS between 10/02/13 and 07/30/15 were identified and followed historically for 2 years. Demographic information, medical history, and fluoroscopic data were collected. The 2-year incidence of pneumonia was obtained from the medical records and telephone interview. The incidence of pneumonia and death were calculated and risk factors for pneumonia and mortality were ascertained. Results: 689 patients were followed for 2 years. The mean age (±standard deviation) of the cohort was 65 (±15.5) years. 49% (338/689) were female. The most common causes of dysphagia were cricopharyngeus muscle dysfunction (270/689), head and neck cancer (175/689), and neurodegenerative disease (56/689). The incidence of pneumonia was 22% (153/689). The incidence of death was 11%. Multivariable logistic regression revealed that chronic obstructive pulmonary disorder [COPD] (odds ratio [OR] = 2.36, 95% confidence interval [CI]: 1.33–4.19), hypertension (OR = 1.82, 95% CI: 1.23–2.73), tracheotomy status (OR = 2.96, 95% CI: 1.09–7.99), and vallecular residue (OR = 1.88, 95% CI: 1.24–2.85) were all significantly associated with an elevated risk of pneumonia. Kidney disease (OR = 1.27, 95% CI: 1.02–9.9), COPD (OR = 3.27, 95% CI: 1.65–6.49), vallecular residue (OR = 2.35, 95% CI: 1.35–4.1), male gender (OR = 2.21, 95% CI: 1.25–3.92), and low body mass index (OR: 1.12, 95% CI: 1.06–1.19) were independent adjusted risk factors for death. Conclusions: The incidence of aspiration pneumonia (22%) and death (11%) within 2-years of a VFSS was high. The greatest adjusted risk factors for incident pneumonia were tracheotomy (OR = 3.0), COPD (OR = 2.4) and vallecular residue (OR = 1.9). The greatest adjusted risk factors for death were COPD (OR = 3.3), vallecular residue (OR = 2.3), and male gender (OR = 2.2). Level of Evidence: 4 Laryngoscope, 132:1172–1176, 2022.
AB - Objectives/Hypothesis: To identify risk factors for pneumonia incidence in patients with dysphagia undergoing a videofluoroscopic swallow study (VFSS) in an outpatient tertiary-care center. Study Design: Historical cohort study. Methods: All individuals undergoing a VFSS between 10/02/13 and 07/30/15 were identified and followed historically for 2 years. Demographic information, medical history, and fluoroscopic data were collected. The 2-year incidence of pneumonia was obtained from the medical records and telephone interview. The incidence of pneumonia and death were calculated and risk factors for pneumonia and mortality were ascertained. Results: 689 patients were followed for 2 years. The mean age (±standard deviation) of the cohort was 65 (±15.5) years. 49% (338/689) were female. The most common causes of dysphagia were cricopharyngeus muscle dysfunction (270/689), head and neck cancer (175/689), and neurodegenerative disease (56/689). The incidence of pneumonia was 22% (153/689). The incidence of death was 11%. Multivariable logistic regression revealed that chronic obstructive pulmonary disorder [COPD] (odds ratio [OR] = 2.36, 95% confidence interval [CI]: 1.33–4.19), hypertension (OR = 1.82, 95% CI: 1.23–2.73), tracheotomy status (OR = 2.96, 95% CI: 1.09–7.99), and vallecular residue (OR = 1.88, 95% CI: 1.24–2.85) were all significantly associated with an elevated risk of pneumonia. Kidney disease (OR = 1.27, 95% CI: 1.02–9.9), COPD (OR = 3.27, 95% CI: 1.65–6.49), vallecular residue (OR = 2.35, 95% CI: 1.35–4.1), male gender (OR = 2.21, 95% CI: 1.25–3.92), and low body mass index (OR: 1.12, 95% CI: 1.06–1.19) were independent adjusted risk factors for death. Conclusions: The incidence of aspiration pneumonia (22%) and death (11%) within 2-years of a VFSS was high. The greatest adjusted risk factors for incident pneumonia were tracheotomy (OR = 3.0), COPD (OR = 2.4) and vallecular residue (OR = 1.9). The greatest adjusted risk factors for death were COPD (OR = 3.3), vallecular residue (OR = 2.3), and male gender (OR = 2.2). Level of Evidence: 4 Laryngoscope, 132:1172–1176, 2022.
KW - Risk factors
KW - dysphagia
KW - mortality
KW - pneumonia
KW - swallowing impairment
UR - http://www.scopus.com/inward/record.url?scp=85111349039&partnerID=8YFLogxK
U2 - 10.1002/lary.29770
DO - 10.1002/lary.29770
M3 - مقالة
C2 - 34313344
SN - 0023-852X
VL - 132
SP - 1172
EP - 1176
JO - Laryngoscope
JF - Laryngoscope
IS - 6
ER -
