Affiliation:
1. University of Pittsburgh School of Medicine Pittsburgh Pennsylvania U.S.A.
2. Division of Pediatric Otolaryngology, Department of Otolaryngology UPMC Children's Hospital of Pittsburgh Pittsburgh Pennsylvania U.S.A.
3. Office of Research and Development Veterans Affairs Pittsburgh Healthcare System Pittsburgh Pennsylvania U.S.A.
4. Division of Pediatric Otolaryngology, Department of Otolaryngology University of Utah Salt Lake City Utah U.S.A.
Abstract
ObjectiveWhile management protocols of pediatric esophageal foreign bodies (EFBs) are well‐delineated, resource utilization can be improved. This study's objectives were to explore hospital charges/costs for pediatric patients who present with EFBs and to identify patient risk factors associated with esophageal injury.MethodsA retrospective chart review of patients undergoing aerodigestive foreign body removal at a tertiary‐care children's hospital from 2018 to 2021 was conducted. Data collected included demographics, medical history, presenting symptoms, EFB type, surgical findings, and hospital visit charges/costs.Results203 patients were included. 178 of 203 (87.7%) patients were admitted prior to operation. Unwitnessed EFB ingestion (p < 0.001, OR = 15.1, 95% CI = 5.88–38.6), experiencing symptoms for longer than a week (p < 0.001, OR = 11.4, 95% CI = 3.66–38.6) and the following presenting symptoms increased the odds of esophageal injury: dysphagia (p = 0.04, OR = 2.45, 95% CI = 1.02–5.85), respiratory distress (p = 0.005, OR = 15.5, 95% CI = 2.09–181), coughing (p < 0.001, OR = 10.1, 95% CI = 3.73–28.2), decreased oral intake (p = 0.001, OR = 6.60, 95% CI = 2.49–17.7), fever (p = 0.001, OR = 5.52, 95% CI = 1.46–19.6), and congestion (p = 0.001, OR = 8.15, 95% CI = 2.42–27.3). None of the 51 asymptomatic patients had esophageal injury. The median total charges during the encounter was $20,808 (interquartile range: $18,636–$24,252), with operating room (OR) (median: $5,396; 28.2%) and inpatient admission (median: $5,520; 26.0%) contributing the greatest percentage.ConclusionsAsymptomatic patients with EFBs did not experience esophageal injury. The OR and inpatient observation accounted for the greatest percentage of the hospital charges. These results support developing a potential algorithm to triage asymptomatic patients to be managed on a same‐day outpatient basis to improve the value of care.Level of EvidenceLevel 3 Laryngoscope, 2024