Abstract
Purpose: Postoperative aspiration pneumoniae in elderly patients leads to an extended hospital stay and reduction of QOL. This study was designed to evaluate the usefulness of a perioperative intervention, which we refer to as the “Preventative Program of Aspiration Pneumoniae” (PPAP), for prevention of postoperative aspiration pneumoniae in elderly patients with gastrointestinal cancer. Materials and Methods: The PPAP consists of (1) identification of patients aged ≥80 years old with PS 1 or higher and those aged 75–79 years old with suspected swallowing dysfunction based on a questionnaire to screen for dysphagia, (2) evaluation of swallowing function using the Hyodo score, (3) identification of patients requiring postoperative swallowing rehabilitation, and (4) postoperative swallowing rehabilitation. A total of 262 patients aged ≥75 years old who underwent radical surgery for gastrointestinal cancer excluding esophageal cancer between January 2020 and April 2021 were evaluated retrospectively. The patient backgrounds and incidence of postoperative aspiration pneumoniae in 52 patients with PPAP intervention were compared with those for 210 patients without PPAP intervention. Result: Patients with PPAP intervention were significantly older (P<0.01) and had significantly lower preoperative albumin (P<0.01) and preoperative PNI (P=0.03) compared with patients without PPAP intervention. Of the 52 PPAP patients, 10 underwent postoperative swallowing rehabilitation and 42 were evaluated for aspiration at the start of meals. The incidence of postoperative aspiration pneumoniae was 0/52 (0%) in patients with PPAP intervention and 5/210 (2.4%) in those without PPAP intervention, but did not differ significantly (P=0.26). Conclusion: Perioperative intervention with PPAP was useful for prevention of postoperative aspiration pneumoniae. Preoperative screening of high-risk patients and aggressive postoperative intervention are useful for prevention of postoperative aspiration pneumoniae in elderly patients.
