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Special Communication
November 2013

Dysphagia: Perspectives on an Old Problem: The Hayes Martin Lecture, 2013

Author Affiliations
  • 1University of Pittsburgh School of Medicine, Department of Otolaryngology, Eye and Ear Institute, Pittsburgh, Pennsylvania
JAMA Otolaryngol Head Neck Surg. 2013;139(11):1256-1258. doi:10.1001/jamaoto.2013.2639

Aspiration describes the abnormal event when foreign material is taken into the lungs. Under some circumstances, aspiration may result in pneumonitis or pneumonia. It is commonly recognized that pneumonia is a common pathway for many terminal patients irrespective of diagnosis. It has been held that pneumonia is “the old man’s friend,” while Dr William Osler stated that pneumonia was “the captain of the men of death.”1 It is appropriate, however, that surgeons have a different perspective on hospital-acquired pneumonia. In a review of the Nationwide Inpatient Sample, data from a cohort of 93 633 patients studied between 2003 and 2008 indicated that pneumonia developed in 6035 (6%). Risk factors identified were comorbidity, chronic obstructive pulmonary disease, weight loss, and dysphagia.2 These data suggest that nosocomial pneumonia is a problem and that there may be room for process improvement. Interest in aspiration pneumonia has taken on new meaning when the Centers for Medicare & Medicaid Services has indicated that they may deny payment for hospital-acquired infections.