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A Simple Risk Scoring System for Predicting the Occurrence of Aspiration Pneumonia After Gastric Endoscopic Submucosal Dissection

 Kyemyung Park  ;  Na Young Kim  ;  Ki Jun Kim  ;  Chaerim Oh  ;  Dongwoo Chae  ;  So Yeon Kim 
 ANESTHESIA AND ANALGESIA, Vol.134(1) : 114-122, 2022-01 
Journal Title
Issue Date
Aged ; Area Under Curve ; Endoscopic Mucosal Resection / adverse effects* ; Female ; Humans ; Incidence ; Machine Learning ; Male ; Middle Aged ; Multivariate Analysis ; Pneumonia, Aspiration / diagnosis* ; Pneumonia, Aspiration / etiology* ; Postoperative Complications ; Predictive Value of Tests ; Probability ; ROC Curve ; Retrospective Studies ; Risk ; Risk Assessment / standards* ; Risk Factors ; Stomach / surgery ; Stomach Neoplasms / complications* ; Stomach Neoplasms / surgery*
Background: Aspiration pneumonia after endoscopic submucosal dissection (ESD) is rare, but can be fatal. We aimed to investigate risk factors and develop a simple risk scoring system for aspiration pneumonia.

Methods: We retrospectively reviewed medical records of 7833 patients who underwent gastric ESD for gastric neoplasm under anesthesiologist-directed sedation. Candidate risk factors were screened and assessed for significance using a least absolute shrinkage and selection operator (LASSO)-based method. Top significant factors were incorporated into a multivariable logistic regression model, whose prediction performance was compared with those of other machine learning models. The final risk scoring system was created based on the estimated odds ratios of the logistic regression model.

Results: The incidence of aspiration pneumonia was 1.5%. The logistic regression model showed comparable performance to the best predictive model, extreme gradient boost (area under receiver operating characteristic curve [AUROC], 0.731 vs 0.740). The estimated odds ratios were subsequently used for the development of the clinical scoring system. The final scoring system exhibited an AUROC of 0.730 in the test dataset with risk factors: age (≥70 years, 4 points), male sex (8 points), body mass index (≥27 kg/m2, 4 points), procedure time (≥80 minutes, 5 points), lesion in the lower third of the stomach (5 points), tumor size (≥10 mm, 3 points), recovery time (≥35 minutes, 4 points), and desaturation during ESD (9 points). For patients with total scores ranging between 0 and 33 points, aspiration pneumonia probabilities spanned between 0.1% and 17.9%. External validation using an additional cohort of 827 patients yielded AUROCs of 0.698 for the logistic regression model and 0.680 for the scoring system.

Conclusions: Our simple risk scoring system has 8 predictors incorporating patient-, procedure-, and sedation-related factors. This system may help clinicians to stratify patients at risk of aspiration pneumonia after ESD.
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pharmacology (약리학교실) > 1. Journal Papers
Yonsei Authors
Kim, Ki Jun(김기준) ORCID logo https://orcid.org/0000-0003-1950-7998
Kim, Na Young(김나영) ORCID logo https://orcid.org/0000-0003-3685-2005
Kim, So Yeon(김소연) ORCID logo https://orcid.org/0000-0001-5352-157X
Chae, Dong Woo(채동우) ORCID logo https://orcid.org/0000-0002-7675-3821
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