Emergency management for patients with caustic ingestion in high-volume centers is associated with improved early survival rates, according to a study in JAMA Surgery.
Researchers assessed nationwide epidemiology and early outcomes associated with caustic ingestion among patients in France using data from the French Medical Information System Database, from January 2010 to December 2019.
A total of 22,657,226 patients were admitted to hospitals in France on an emergency outpatient basis, of whom 3544 (0.016%) were admitted with caustic ingestion. These participants had a median age of 49 (IQR, 34-63) years, and 1685 (47.5%) were women.
Of the cohort, 1124 patients (32%) received treatment at low-volume centers, 1224 (34%) at medium-volume centers, and 1196 (34%) at high-volume centers. Of those who were admitted to low- and medium-volume centers, 76 (3.2%) were transferred to a larger center.
The number of hospital admissions for caustic ingestion per year remained stable during the study period, although the number of unintentional ingestion incidents increased steadily. At the beginning of the period, less than 5% (34 of 744) of ingestion incidents were unintentional, compared with about 20% (119 of 671) at the end of the period.
Surgical resection was conducted in 388 patients (11%) during their primary hospital stay, with 156 (40%) esophageal resections, 103 (27%) esophagogastrectomies, and 98 (25%) gastric resections. Nonsurgical management was performed in 3156 patients (89%).
A total of 1198 patients (34%) had a complication and 294 (8%) died. The most common adverse event was a pulmonary complication, which occurred in 869 patients (24%). During emergency management, 1418 patients (40%) were admitted to the intensive care unit (ICU).
Multivariate analysis showed that independent predictors of mortality were older age (odds ratio [OR], 1.06; 95% CI, 1.05-1.07; P <.001), higher comorbidity score (OR, 1.14; 95% CI, 1.08-1.20; P <.001), suicidal ingestion (OR, 3.45; 95% CI, 1.85-7.14; P <.001), ICU admission (OR, 4.42; 95% CI, 3.17-6.21; P <.001), emergency surgery for digestive necrosis (OR, 3.44; 95% CI, 2.47-4.78; P <.001), and treatment in low-volume centers (OR, 1.45; 95% CI, 1.01-2.08; P =.04).
“A major finding was the significant improvement of in-hospital survival in patients treated in high-volume centers,” the investigators commented. “Such survival benefits may be associated with a better selection of patients for surgery, improved intraoperative and postoperative management strategies, and wide access to multidisciplinary management.”
Study limitations include use of an administrative database that was developed for financial instead of research purposes. In addition, the study design did not allow for patient follow-up, and thus long-term nutritional and survival analyses are not provided. The analysis could be biased by the exclusion of out-of-hospital fatalities. Finally, cultural or familial factors may be involved but could not be assessed.
“[R]eferral to expert centers was associated with early survival after caustic ingestion,” concluded the researchers. “If feasible, low-volume hospitals should transfer patients to larger centers instead of attempting on-site management.”
Disclosure: Some of the study authors declared affiliations with pharmaceutical companies. Please see the original reference for a full list of authors’ disclosures.
Challine A, Maggiori L, Katsahian S, et al. Outcomes associated with caustic ingestion among adults in a national prospective database in France. JAMA Surg. Published online December 8, 2021. doi: 10.1001/jamasurg.2021.6368