Abstract 2314: The epidemiology and impact of aspiration pneumonia in patients admitted with esophageal cancer: a nationwide data analysis

Background: Esophageal cancer (EC) is frequently associated with dysphagia, arising from tumor invasion or treatment-related adverse effects, such as surgical resection or chemoradiation. Dysphagia substantially increases the risk of aspiration pneumonia (AP), a frequent complication in this population. Despite the established link between AP and head and neck cancers, its epidemiology and clinical impact in patients with EC remain underexplored. This study aims to delineate the burden of AP in EC hospitalizations and its effect on inpatient outcomes, addressing a critical gap in oncological and infectious disease literature. Methods: Hospitalizations with a primary diagnosis of EC were extracted from the National Inpatient Sample (NIS) from 2019 to 2021, using ICD-10 codes. The cohort was split by the presence or absence of AP. Sociodemographic variables, comorbidities and the presence of concurrent COVID-19 infection were assessed. The primary outcome was all-cause in-hospital mortality, with secondary outcomes including rates of complications, resource utilization, length of stay (LOS), and hospitalization costs. Multivariate regression analyses were conducted with statistical significance set at p < 0.05. Results: Among 42,059 EC hospitalizations, 3,550 (8.4%) were complicated by AP. The AP cohort was older (mean age 67.9 vs. 66.6 years; p < 0.05), predominantly from the southern United States (36.6%; p < 0.05), and exhibited a higher prevalence of severe comorbidities (Charlson Comorbidity Index ≥ 3: 79.1% vs. 75.4%; p < 0.05). AP was independently associated with a significantly elevated risk of in-hospital mortality (adjusted odds ratio [aOR] 3.28; 95% CI, 2.60-4.13). Furthermore, patients with AP demonstrated increased odds of respiratory failure (aOR 7.50; 95% CI, 6.35-8.86), mechanical ventilation (aOR 4.64; 95% CI, 3.68-5.86), severe sepsis (aOR 10.65; 95% CI, 8.15-13.92), and vasopressor use (aOR 3.11; 95% CI, 2.08-4.64). Additionally higher odds of shock (aOR 5.18; 95% CI, 4.10-6.52), acute kidney injury (aOR 2.11; 95% CI, 1.74-2.55), and deep venous thrombosis (aOR 2.13; 95% CI, 1.56-2.92) were seen. Hospitalizations involving AP were associated with significantly prolonged LOS (16.03 vs. 8.05 days; adjusted incidence rate ratio [aIRR] 1.89; 95% CI, 1.76-2.05) and higher total costs ($232,449 vs. $122,488; aIRR 1.84; 95% CI, 1.63-2.07). Conclusions: Hospitalizations of EC patients complicated by AP are associated with markedly increased odds of in-hospital mortality, severe complications, prolonged LOS, and higher healthcare costs. These findings underscore the necessity for targeted interventions to mitigate AP-associated morbidity and mortality in this high-risk patient population. Further research should focus on optimizing preventative and therapeutic strategies to improve clinical outcomes in this subset of oncology patients. Citation Format: Abdu Mohammed, Adamsegd I. Gebremedhen, Yifang Song, Mamdouh Souleymane, Ibrahim Shanti, Malik Samardali, Toni O. Pacioles. The epidemiology and impact of aspiration pneumonia in patients admitted with esophageal cancer: a nationwide data analysis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 2314.