Incidence, Clinical Outcomes and Healthcare Costs of Aspiration Pneumonia in a Tertiary Hospital: A Retrospective Cohort Study

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.