Patient characteristics, outcomes and hospital-level healthcare costs of foreign body ingestion from an Australian, non-prison referral centre

Abstract

ObjectiveForeign body ingestion (FBI) occurs infrequently but can be associated with rare risks including perforation. There is limited understanding of the impact of adult FBI in Australia. We aim to evaluate patient characteristics, outcomes and hospital costs of FBI.DesignA retrospective cohort study of patients with FBI was performed at a non-prison referral centre in Melbourne, Australia. International Classification of Disease-10 coding identified patients with gastrointestinal FBI over financial years 2018–2021. Exclusion criteria were food bolus, medication foreign body, object in anus or rectum, or non-ingestion. Criteria for ‘emergent’ classification were oesophagus, size >6 cm, disc batteries, airway compromise, peritonitis, sepsis and/or suspected viscus perforation.ResultsThirty-two admissions attributed to 26 patients were included. The median age was 36 years (IQR: 27–56), 58% were male and 35% had a prior psychiatric or autism spectrum disorder. There were no deaths, perforations or surgery. Gastroscopy was performed in 16 admissions and 1 was scheduled following discharge. Rat-tooth forceps were used in 31% and an overtube was used in 3 cases. The median time from presentation to gastroscopy was 673 minutes (IQR: 380–1013). Management was adherent to European Society of Gastrointestinal Endoscopy guidelines in 81%. After excluding admissions with FBI as a secondary diagnosis, median admission cost was $A1989 (IQR: $A643–$A4976) and total admission costs over the 3 years was $A84 448.ConclusionFBI in an Australian, non-prison referral centre is infrequent, can often be safely managed expectantly, and has limited impact on healthcare utilisation. Early, outpatient endoscopy could be considered for non-urgent cases, which may reduce costs while maintaining safety.

The global, regional, and national burden of foreign bodies from 1990 to 2019: a systematic analysis of the global burden of disease study 2019

“…There are many dangerous products and situations in these working environments, which are likely to lead to FB-related accidents. To reduce the risk of FBs among males, all levels of society should strengthen publicity and safety education, pay attention to eating habits, avoid eating food that is too hard or too large, strengthen personal protection during work, wear protective equipment, and avoid preventable FBs [2,30]. For example, in 2009, China promulgated the Interim Provisions on Supervision and Supervision of Occupational Health in the Workplace to ensure legal prevention, control, and elimination of hazards to reduce the occurrence of FB incidents at the root and make the diagnosis and treatment of FBs more standardized [29].…”