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Outcomes Associated With Caustic Ingestion Among Adults in a National Prospective Database in France

Educational Objective
To identify outcomes associated with caustic ingestion among adults from a national database.
1 Credit CME
Key Points

Question  What are the outcomes associated with caustic ingestion in adults?

Findings  In this observational study, 1198 patients (34%) presented complications following caustic ingestion, mostly pulmonary; 388 (11%) required surgery for digestive necrosis; and 284 (8%) died. Severity of ingestion and hospital volume were associated with mortality.

Meanings  Emergency management of caustic injuries in high-volume centers may improve survival rates.

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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Article Information

Accepted for Publication: September 26, 2021.

Published Online: December 8, 2021. doi:10.1001/jamasurg.2021.6368

Corresponding Author: Léon Maggiori, MD, PhD, Service de Chirurgie Viscérale, Cancérologique et Endocrinienne, Hôpital 13 Saint Louis, Assistance Publique des Hôpitaux de Paris, Université de Paris, One avenue Claude Vellefaux, 75010 Paris, France (leon.maggiori@aphp.fr).

Author Contributions: Drs Challine and Maggiori had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: Challine, Maggiori, Corté, Lazzati, Cattan, Chirica.

Drafting of the manuscript: Challine, Maggiori, Corté, Lazzati, Cattan, Chirica.

Critical revision of the manuscript for important intellectual content: Challine, Maggiori, Katsahian, Corté, Goere, Cattan, Chirica.

Statistical analysis: Challine, Maggiori, Lazzati, Cattan.

Administrative, technical, or material support: Challine, Corté, Lazzati.

Supervision: Maggiori, Katsahian, Goere, Cattan, Chirica.

Conflict of Interest Disclosures: Dr Goere reports personal fees from Merck Serono and Sanofi outside the submitted work. Dr Lazzati reports paid lectures for Johnson & Johnson and Gore outside the submitted work. No other disclosures were reported.

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