JAMA Surg. 2021 Dec 08; doi: 10.1001/jamasurg.2021.6368. Epub 2021 Dec 08.
Outcomes Associated With Caustic Ingestion Among Adults in a National Prospective Database in France.
JAMA surgery
Alexandre Challine, Léon Maggiori, Sandrine Katsahian, Hélène Corté, Diane Goere, Andrea Lazzati, Pierre Cattan, Mircea Chirica
Affiliations
Affiliations
- Service de Chirurgie Viscérale, Cancérologique et Endocrinienne, Hôpital 13 Saint Louis, Assistance Publique des Hôpitaux de Paris, Université de Paris, Paris, France.
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1138 Team 22, Centre de Recherche des Cordeliers, Paris, France.
- Université de Paris, Assistance Publique des Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Unité d'Épidémiologie et de Recherche Clinique, Institut National de la Santé et de la Recherche Médicale, Centre d'Investigation Clinique 1418, Module Épidémiologie Clinique, Paris, France.
- Department of General Surgery, Centre Hospitalier Intercommunal de Créteil, 40 Avenue de Verdun, 94000 Créteil, France.
- Institut National de la Santé et de la Recherche Médicale, L'Institut Mondor de Recherche Biomédicale, U955, Université Paris-Est Créteil, France.
- Department of Digestive Surgery, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France.
PMID: 34878529
DOI: 10.1001/jamasurg.2021.6368
Abstract
IMPORTANCE: Caustic ingestion in adults may result in death or severe digestive sequelae. The scarcity of nationwide epidemiological data leads to difficulties regarding the applicability of their analysis to less specialized centers, which are nevertheless largely involved in the emergency management of adverse outcomes following caustic ingestion.
OBJECTIVE: To assess outcomes associated with caustic ingestion in adults across a nationwide prospective database.
DESIGN, SETTINGS, AND PARTICIPANTS: Adult patients aged 16 to 96 admitted to the emergency department for caustic ingestion between January 2010 and December 2019 were identified from the French Medical Information System Database, which includes all patients admitted in an emergency setting in hospitals in France during this period.
EXPOSURE: Esophageal caustic ingestion.
MAIN OUTCOMES AND MEASURES: The primary end point was in-hospital patient outcomes following caustic ingestion. Multivariate analysis was performed to assess independent predictors of in-hospital morbidity and mortality.
RESULTS: Among 22 657 226 patients admitted on an emergency outpatient basis, 3544 (0.016%) had ingested caustic agents and were included in this study. The median (IQR) age in this population was 49 (34-63) years, and 1685 patients (48%) were women. Digestive necrosis requiring resection was present during the primary hospital stay in 388 patients with caustic ingestion (11%). Nonsurgical management was undertaken in 3156 (89%). A total of 1198 (34%) experienced complications, and 294 (8%) died. Pulmonary complications were the most frequent adverse event, occurring in 869 patients (24%). On multivariate analysis, predictors of mortality included old age, high comorbidity score, suicidal ingestion, intensive care unit admission during management, emergency surgery for digestive necrosis, and treatment in low-volume centers. On multivariate analysis, predictors of morbidity included old age, higher comorbidity score, intensive care unit admission during management, and emergency surgery for digestive necrosis.
CONCLUSIONS AND RELEVANCE: In this study, referral to expert centers was associated with improved early survival after caustic ingestion. If feasible, low-volume hospitals should consider transferring patients to larger centers instead of attempting on-site management.
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