2 Highlights-Postoperative aspiration pneumonia is a rare complication, however, remains a severe disease with a significant mortality of 27% in this series.-Increasing age, the need for intraoperative blood component transfusion and bilateral pulmonary infiltrates are independent risk factors for fatal outcome after aspiration pneumonia.-The identification of those patients at increased risk for death after aspiration may help to further improve patients outcome. Conclusion: Postoperative aspiration pneumonia remains a severe complication with significant mortality. Increasing age, the need for intraoperative blood component transfusion and bilateral pulmonary infiltrates are independent risk factors for fatal outcome after aspiration pneumonia. Therefore, these patients suffering aspiration pneumonia require special attention and increased monitoring.