RESEARCH – November 2017

Perioperative pulmonary aspiration at Tartu University Hospital

Authors: Hans-Erik Ehrlich, Alar Sõrmus, Alar Rokk, Juri Karjagin

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Abstract

Aspiration pneumonitis is a rare anaesthesiarelated complication which is caused by perioperative regurgitation and aspiration of gastric contents. The objective of our study was to retrospectively determine the incidence, management and risk factors of perioperative aspiration pneumonitis cases at Tartu University Hospital during 2011-2014. Similar studies have been conducted in ohter centres but there is a lack of data about perioperative aspiration pneumonitis in Estonia.

We performed a retrospective crosssectional study. The study group included 80,133 anaesthesia cases at Tartu University Hospital during 2011-2014 (both adults and children) of which 17,387 (21.7%) were emergency cases. We found cases of 44 patients with confirmed regurgitation of gastric contents, using our anaesthetic incidence reporting database and electronic health records. Perioperative aspiration was discriminated from regurgitation by presence of gastric contents in the tracheobronhial tree and/or radiographic evidence. Cases were studied individually by one researcher to determine the diagnosis, risk factors and management of these patients.

Forty-four patients in the study group had regurgitation of gastric contents and 20 cases involved confirmed perioperative pulmonary aspiration. Thirty-three patients had risk factors for regurgitation and 24 patients had multiple risk factors; the most frequent risk factors were emergency surgery and gastro-enteral pathology. Anaesthetic management did not affect the frequency of aspiration or outcome. Four patients with confirmed pulmonary aspiration died due to pulmonary complications. The incidence of perioperative regurgitation of gastric contents was 1:1821, the incidence of aspiration pneumonitis was 1:4007 and the incidence of mortality was 1:20033.

The incidence and mortality of perioperative pulmonary aspiration at Tartu University Hospital is higher compared with that in previous international studies. The reasons for this should be further analysed in a prospective study.