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Resource Utilization and Risk Factors for Esophageal Injury in Pediatric Esophageal Foreign Bodies

Basil Hashimi1, Amber D Shaffer2, Jennifer L McCoy3

  • 1University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A.

The Laryngoscope
|April 29, 2024
PubMed

Insights

Pediatric esophageal foreign bodies (EFBs) in asymptomatic patients did not cause injury, suggesting outpatient management could improve care value. This approach may reduce hospital charges associated with EFB removal.

Area of Science:

  • Pediatric Gastroenterology
  • Otolaryngology
  • Health Services Research

Background:

  • Management protocols for pediatric esophageal foreign bodies (EFBs) exist but can be optimized for resource utilization.
  • Understanding patient risk factors for esophageal injury is crucial for effective management.

Purpose of the Study:

  • To analyze hospital charges and costs for pediatric patients with EFBs.
  • To identify patient-specific risk factors associated with esophageal injury in pediatric EFB cases.

Main Methods:

  • Retrospective chart review of pediatric patients undergoing aerodigestive foreign body removal (2018-2021).
  • Data included demographics, medical history, symptoms, EFB type, surgical findings, and hospital charges/costs.
  • Statistical analysis to identify risk factors for esophageal injury and cost drivers.

Main Results:

  • 203 pediatric patients were included; 87.7% required admission.
  • Unwitnessed ingestion, prolonged symptoms (>1 week), dysphagia, respiratory distress, coughing, decreased oral intake, fever, and congestion increased odds of esophageal injury.
  • Asymptomatic patients (n=51) showed no esophageal injury.
  • Median total charges were $20,808, with operating room (28.2%) and inpatient admission (26.0%) being the highest cost contributors.

Conclusions:

  • Asymptomatic pediatric patients with EFBs do not experience esophageal injury.
  • Operating room time and inpatient observation represent the largest components of hospital charges.
  • Developing an algorithm to triage asymptomatic patients for same-day outpatient management could enhance the value of care.
Abstract

Keywords:
algorithmsesophageal foreign body removalesophageal injuryhospital costspatient managementpediatric otolaryngology

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