Clinical outcomes of sharp esophageal foreign bodies in elderly patients: a retrospective study from Wuhan, China

This study aimed to explore the clinical characteristics, treatment determinants, and outcomes of elderly patients with sharp esophageal foreign bodies (EFBs) in Wuhan, China.

We conducted a retrospective analysis of 58 elderly patients (≥65 years) with sharp EFBs treated at Wuhan Central Hospital from January 2017 to June 2023. Patients were allocated to either an endoscopic (n = 43) or surgical (n = 15) treatment group based on clinical severity. We analyzed demographics, EFB type, injury severity, pre-hospital delay, laboratory findings, length of hospital stay, and functional outcomes using the Barthel Index. Statistical comparisons, including effect sizes and 95% confidence intervals, were performed, and a multivariable logistic regression analysis was conducted to identify independent predictors for surgical intervention.

No significant differences were observed in baseline demographics (p > 0.05). Fish bones (60.3%) were the most common EFB. Factors significantly associated with requiring surgical treatment included longer pre-hospital delay (median 3.0 vs. 0.5 days, p < 0.001), presence of fever (60.0% vs. 4.7%, p < 0.001), leukocytosis (46.7% vs. 16.3%, p = 0.031), dysphagia (20.0% vs. 2.3%, p = 0.041), and pre-existing esophageal diseases (53.3% vs. 14.0%, p = 0.004). All patients in the surgical group had esophageal perforation or a peri-esophageal abscess, compared to only 25.6% in the endoscopic group (p < 0.001). Multivariable analysis identified pre-hospital delay (OR 2.55, 95% CI [1.29-5.04]) and presence of fever at admission (OR 15.8, 95% CI [3.01-82.9]) as independent predictors for surgery. Endoscopic treatment was associated with a significantly shorter hospital stay (mean 4.3 vs. 13.7 days, p < 0.001) and superior functional recovery at discharge (p = 0.008) and 1 month post-procedure (p < 0.001).

Delayed medical consultation, severe complications like perforation and abscess, and underlying esophageal comorbidities are key factors necessitating surgical intervention for sharp EFBs in the elderly. Fever at admission and pre-hospital delay are strong independent predictors of the need for surgery. Prompt diagnosis and endoscopic management, when feasible, are associated with shorter hospitalizations and better functional outcomes.