Open Access

ARTICLE

Implications of postoperative pulmonary aspiration following major urologic surgery

Eric J. Kirshenbaum^1,2, Robert H. Blackwell^1,2, Belinda Li¹, Anai N. Kothari^2,3, Paul C. Kuo^2,3, Robert C. Flanigan¹, Alex Gorbonos¹, Gopal N. Gupta^1,2

1 Department of Urology, Loyola University Medical Center, Maywood, Illinois, USA
2 One:MAP Division of Clinical Informatics and Analytics, Loyola University Medical Center, Maywood, Ilinois, USA
3 Department of Surgery, Loyola University Medical Center, Maywood, Ilinois, USA
Address correspondence to Dr. Eric J. Kirshenbaum, Dept. of Urology, Loyola University Medical Center, 2160 S. First Avenue, Fahey Center, Room 241, Maywood, IL 60153 USA

Canadian Journal of Urology 2018, 25(1), 9186-9192.

Abstract

Introduction: The purpose of this article is to assess the incidence of pulmonary aspiration following major urologic surgery, identify predictors of an aspiration event, and evaluate subsequent clinical outcomes.
Materials and methods: The Healthcare Cost and Utilization Project State Inpatient Database for California (2007–2011) was used to identify patients undergoing cystectomy, prostatectomy, partial nephrectomy, and radical nephrectomy. Aspiration events were identified within 30 days post-surgery. The primary outcome was 30-day mortality; secondary outcomes included total length of hospital stay, discharge location, and diagnoses of acute renal failure, pneumonia, or sepsis. Descriptive statistics were performed. A multivariable logistic regression model was used to determine independent predictors of aspiration. A separate non-parsimonious logistic regression model was fit to assess the independent effect of aspiration on 30-day mortality.
Results: Among 84,837 patients undergoing major urologic surgery, 319 (0.4%) experienced an aspiration event. Independent risk factors for aspiration included ileus, congestive heart failure, paraplegia, chronic lung disease, and age ≥ 80 years (all p < 0.01). Patients who aspirated had significantly higher rates of renal failure (36.1% vs. 2.5%), pneumonia (36.1% vs. 2.5%), sepsis (35.7% vs. 0.7%), prolonged length of stay (17 days vs. 3 days), and discharge to a nursing facility (26.3% vs. 2.3%) (all p < 0.001). The 30-day mortality rate after aspiration was 20.7%, compared with 0.8% in non-aspirated patients (p < 0.001). Aspiration independently increased the risk of 30-day mortality (OR = 3.1, 95% CI: 2.2–4.5).
Conclusions: Postoperative pulmonary aspiration following major urologic surgery is a rare but devastating complication associated with significantly increased morbidity and mortality. Precautions should be taken in high-risk patient populations to prevent such events.

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