Aspiration pneumonia related surgical deaths: a review of a 10 year Australian state-based mortality audit

Background: Acute respiratory problems are a frequent cause of death in surgical patients, however little is known about the specific impact of aspiration pneumonia (AP). This descriptive analysis examines AP related surgical deaths, trends over time and associated co-morbidities. Methods: A retrospective review was conducted on the NSW Collaborating Hospitals' Audit of Surgical Mortality database, a state-based audit, which examines all deaths of patients under the care of a surgeon. A 10-year period from 2008 to 2017 was reviewed. Results: Over 10 years, the total number of AP related deaths was 1103, an average of 5.2% of all notified surgical deaths (n = 21 038). AP was the main factor in death in 53.5%, and a contributory factor in 46.5% of those patient deaths (p < 0.001). The majority were male (61.4%), age ≥ 70 (84.6%), with an ASA of ≥ 3 (85%). Most AP related deaths were during an emergency admission (85%). Surgery was performed within 30 days of death in 84%. Admissions were predominantly under general (42.2%) or orthopaedic surgeons (33.3%), followed by neurosurgery (9.1%) and vascular surgery (6.9%). Significant associations were seen in risk factors of age ≥ 70 yo, respiratory and neurological co-morbidities. Conclusion: This 10 year review highlights the impact of AP on surgical mortality. Improved recognition may reduce the risk of this devastating outcome.