Major study clarifies risks, severity of perioperative pulmonary aspiration

Editor's Note

Preliminary results from a nearly million-case review reveal that perioperative pulmonary aspiration, while feared, is rare but potentially deadly. According to a February 4 Anesthesiology News report, researchers found an overall incidence of 1 in 5,572 anesthesia cases, with aspiration-related mortality at about 1 in 67,000.

As detailed in the article, the retrospective analysis examined 941,595 elective, urgent, and emergent anesthesia cases in adults and children treated between 2016 and 2023 at seven Mass General Brigham hospitals. Only cases with high-likelihood confirmation via bronchoscopy, chest imaging, or direct visualization were included. Severe aspiration was defined by outcomes such as perioperative death, cardiac arrest, need for mechanical ventilation or high-flow oxygen, extracorporeal membrane oxygenation, or vasopressor use.

The outlet reports that of 169 identified aspiration cases, 47% occurred in elective procedures, 37% in urgent cases, and 15% in emergent cases. Most incidents arose during induction or airway management under general anesthesia or monitored anesthesia care, with gastric or bilious material aspirated in 60% of cases. Severe aspiration occurred in 43% of patients, and aspiration led to death in 14 patients, yielding an 8% mortality rate among those affected.

Severe cases were more common in urgent and emergent procedures, non-OR settings such as endoscopy and interventional radiology suites, and among patients with higher ASA physical status, per the article. Severe cases also had higher rates of comorbidities such as gastroesophageal reflux disease, obesity, and multiple aspiration risk factors. Regurgitation was the most common cause, with only 10% of events linked to difficult intubation or cardiac arrest.

Over half of aspiration cases caused intraoperative oxygen desaturation, lasting a median of 3 minutes in nonsevere cases and 6 minutes in severe cases. Six patients in the severe group suffered intraoperative cardiac arrest due to aspiration, but none died during surgery. Postoperatively, 54% of all aspiration patients required no respiratory support, and 79% needed no vasopressors.

While interest is growing around the role of GLP-1 agonists in aspiration risk, the dataset included very few such patients, as data collection predated the drugs’ recent surge in use. For aspiration-risk-related news involving GLP-1s in particular, see these OR Manager briefs: “Study: No significant link between GLP-1 drugs, postoperative aspiration pneumonia” and “Study: GLP-1 drugs heighten risk of gastric residue but not perioperative pulmonary aspiration.”