Aspiration pneumonitis and inpatient outcomes in adult cancer hospitalizations: A 2018–2022 National Inpatient Sample analysis.

Abstract

e23217 Background: Aspiration pneumonitis is frequently conflated with infectious pneumonia in hospitalized oncology populations despite potentially distinct patterns of clinical deterioration and need for intensive care. We compared mortality and indicators of higher-acuity care, including intensive care–level interventions, across aspiration and pneumonia phenotypes in adult cancer hospitalizations. Methods: A serial cross-sectional study of adult hospitalizations with a principal diagnosis of malignancy in the 2018–2022 Healthcare Cost and Utilization Project National Inpatient Sample was performed. Aspiration pneumonitis was identified using any-diagnosis ICD-10-CM codes J69*, and infectious pneumonia using J12–J18. Hospitalizations were categorized using a mutually exclusive exposure variable: (1) neither aspiration nor pneumonia, (2) aspiration pneumonitis only, (3) infectious pneumonia only, and (4) aspiration with infectious pneumonia. Outcomes included in-hospital mortality (primary), mechanical ventilation and shock as escalation-associated endpoints, length of stay (LOS), and hospitalization cost derived using cost-to-charge ratios. Analyses generated national estimates using survey weights with stratification. Multivariable survey-weighted logistic regression was performed to estimate adjusted mortality differences, limited to aspiration-only versus pneumonia-only hospitalizations. Results: Among an estimated 4.81 million cancer hospitalizations that we analyzed, 1.41% were complicated by aspiration pneumonitis alone, 6.04% by infectious pneumonia alone, and 0.22% by combined aspiration and infectious pneumonia. In-hospital mortality differed across phenotypes: 23.97% in aspiration-only hospitalizations, 14.95% in infectious pneumonia alone, and 3.32% in hospitalizations without aspiration or pneumonia. Mechanical ventilation was required in 24.21% of aspiration-only admissions compared with 10.86% in infectious pneumonia, while shock occurred in 7.07% and 3.46%, respectively. Aspiration pneumonitis was associated with longer LOS (16.05 vs 12.39 days) and higher mean cost ($64770 vs $49121) compared with infectious pneumonia. In adjusted analyses comparing aspiration-only with pneumonia-only hospitalizations, aspiration pneumonitis remained independently associated with higher in-hospital mortality (adjusted OR 1.27; 95% CI 1.14–1.42; p < 0.001). Conclusions: Aspiration pneumonitis identifies pulmonary complications among hospitalized adults with cancer, characterized by higher mortality and intensive care–level interventions than infectious pneumonia. Distinguishing aspiration-related events from infectious pneumonia may support earlier risk recognition, targeted airway protection strategies, and proactive planning for higher-acuity care.