三级医院吸入性肺炎的发病率、临床结局与医疗费用：一项回顾性队列研究

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中文摘要

目的： 估算三级医院中由食物或呕吐物所致吸入性肺炎的发病率，描述受影响患者的临床特征与结局，并分析医院获得性与社区获得性吸入性肺炎在死亡率、住院时间和医疗费用方面的差异。
设计： 回顾性观察性队列研究。
方法： 本研究纳入2021年至2023年间诊断为吸入性肺炎的943例机构化成年患者。采用多变量模型分析合并症、功能状态、护理依赖程度和临床结局等数据。将使用容积-黏度吞咽试验进行的吞咽困难筛查作为预防性护理指标进行评价。已获得伦理委员会伦理批准。
结果： 吸入性肺炎的累积发病率为每100次入院3.04例。患者主要为高龄老年人，合并症负担高且功能受损。总死亡率为39.3%。与社区获得性吸入性肺炎相比，医院获得性吸入性肺炎与更高的死亡率、更长的住院时间和更高的医疗费用相关。医院获得性病例的平均总费用为15,163欧元，社区获得性病例为6406欧元。尽管阳性发现比例很高，使用容积-黏度吞咽试验进行的吞咽困难筛查仍明显未被充分利用。
结论： 吸入性肺炎是住院老年人中一种严重且可能可预防的并发症，尤其是在医院获得时。由护士主导的吞咽困难筛查方案可能改善患者安全并优化医疗资源利用。
对专业和/或患者照护的意义： 应在急性和重症照护环境中优先实施系统性的护士主导吞咽困难评估和预防策略。
影响： 医院获得性吸入性肺炎与更差的结局和更高的医疗费用相关。研究结果支持在老年人中实施护士主导的吞咽困难预防策略。
报告方法： 遵循EQUATOR指南，报告由加强观察性流行病学研究报告声明（STROBE）指导。无患者或公众贡献。

英文摘要

AIM: To estimate the incidence of aspiration pneumonia due to food or vomitus in a tertiary hospital, describe the clinical characteristics and outcomes of affected patients, and analyse differences in mortality, length of stay and healthcare costs between in-hospital and community-acquired aspiration pneumonia.
DESIGN: Retrospective observational cohort study.
METHODS: The study included 943 institutionalised adult patients diagnosed with aspiration pneumonia between 2021 and 2023. Data on comorbidities, functional status, nursing care dependency and clinical outcomes were analysed using multivariable models. Dysphagia screening with the Volume-Viscosity Swallow Test was evaluated as a preventive nursing care indicator. Ethical approval was obtained from Ethics Committee.
RESULTS: The cumulative incidence of aspiration pneumonia was 3.04 per 100 admissions. Patients were predominantly older adults with high comorbidity and functional impairment. Overall mortality was 39.3%. In-hospital aspiration pneumonia was associated with higher mortality, longer hospital stay and greater healthcare costs than community-acquired aspiration pneumonia. Mean total costs were €15,163 for in-hospital cases and €6406 for community-acquired cases. Dysphagia screening with the Volume-Viscosity Swallow Test was markedly underutilised despite a high proportion of positive findings.
CONCLUSION: Aspiration pneumonia is a severe and potentially preventable complication among hospitalised older adults, particularly when acquired in hospital. Nurse-led dysphagia screening protocols may improve patient safety and optimise healthcare resource utilisation.
IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Systematic nurse-led dysphagia assessment and prevention strategies should be prioritised in acute and critical care settings.
IMPACT: In-hospital aspiration pneumonia was associated with poorer outcomes and increased healthcare costs. The findings support implementation of nurse-led dysphagia prevention strategies in older adults.
REPORTING METHOD: Following the EQUATOR guidelines, reporting was guided by the Strengthening the Reporting of Observational Studies in Epidemiology Statement (STROBE). No Patient or Public Contribution.