Aspiration pneumonitis (AP) is a serious complication of acute ischemic stroke(AIS) and can lead to significantly worse outcomes and mortality.

Among 3,708,889 AIS hospitalisations, the overall prevalence of AP was 3.68% (95% CI 3.63-3.74%). The prevalence increased from 3.42% in 2016 to 4.08% in 2022. AP was independently associated with a 36% increase in the odds of in-hospital mortality [OR: 1.36, (95% CI: 1.31–1.42)]. The crude mortality rate was over six times higher in patients with AP (21.7% vs. 3.4%, P<0.001). Patients with AP were profoundly less likely to be discharged home (5.0% vs. 37.2%, P<0.001). Furthermore, AP was independently associated with a 43% longer hospital stay and 32% higher total charges. The adjusted mean LOS was 2.0 days longer (6.7 vs. 4.7 days), and adjusted mean total charges were $22,854 higher ($93,171 vs. $70,317) per admission. Among the factors, older age was independently associated with higher odds {OR 1.018, (95% CI 1.017–1.020), p<0.001] while better outcomes noted in females [OR 0.63 (95% CI: 0.61–0.65), p<0.001 )].

AP is serious complication, if present increase mortality and more common in elderly and leads to prolonged hospitalization and poor outcomes. Early interventions to prevent aspiration pneumonitis is required. limitation of this cross-sectional study were accounted.