Preventability of Hospital Deaths in Patients With Non-Ventilator Hospital-Acquired Pneumonia

Abstract Background Crude and adjusted mortality rates for patients with non-ventilator hospital-acquired pneumonia (NV-HAP) are among the highest of all healthcare-associated infections, leading to calls for greater prevention. Patients prone to NV-HAP, however, tend to be severely ill at baseline,...

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Published in:Clinical infectious diseases 2024-08
Main Authors: Tatara, Alexander M, Apostolopoulou, Anna, Agan, Anna A, DelloStritto, Laura, Rhee, Chanu, Klompas, Michael
Format: Article
Language:English
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Summary:Abstract Background Crude and adjusted mortality rates for patients with non-ventilator hospital-acquired pneumonia (NV-HAP) are among the highest of all healthcare-associated infections, leading to calls for greater prevention. Patients prone to NV-HAP, however, tend to be severely ill at baseline, making it unclear whether their high mortality rates are due to NV-HAP, their underlying conditions, or both. Methods Two infectious disease physicians conducted detailed medical record reviews on 150 randomly selected adults from 4 hospitals who died in-hospital following an NV-HAP event between April 2016 and May 2021. Reviewers abstracted risk factors, estimated the preventability of NV-HAP, identified causes of death, and adjudicated the preventability of death. Results The patients’ median age was 69.3 (IQR, 60.7–77.4) years and 43.3% were female. Comorbidities were common: 57% had cancer, 30% chronic kidney disease, 29% chronic lung disease, and 27% had heart failure. At least 1 hospice-eligible condition was present before NV-HAP in 54% and “Do Not Resuscitate” orders in 24%. Most (99%) had difficult-to-modify NV-HAP risk factors: 76% altered mental status, 35% dysphagia, and 27% nasogastric/orogastric tubes. NV-HAP was deemed possibly or probably preventable in 21% and hospital death likely or very likely preventable in 8.6%. Conclusions Most patients who die following NV-HAP have multiple, severe underlying comorbidities and difficult-to-modify risk factors for NV-HAP. Only 1 in 5 NV-HAPs that culminated in death and 1 in 12 deaths following NV-HAP were judged potentially preventable. This does not diminish the importance of NV-HAP prevention programs but informs expectations about the potential magnitude of their impact on hospital deaths.
ISSN:1058-4838
1537-6591
1537-6591
DOI:10.1093/cid/ciae418