The Financial Burden and Health Care Utilization Related to Intentional Versus Unintentional Foreign Body Ingestion in a University Hospital: A Pilot Study

Abstract

Introduction: Foreign body ingestion is a common problem faced by gastroenterologists. Previous literature has focused on accidental foreign body ingestion, primarily in the form of esophageal food impactions. Recently, the cost associated with intentional foreign body ingestion has been recognized as a significant problem. There are no studies assessing the financial impact of intentional foreign body ingestion compared to accidental ingestion. This study assesses the total hospital-related costs of intentional foreign body ingestion compared with unintentional ingestion. Methods: Retrospective review comparing the demographics, hospital length of stay (LOS), and overall cost for episodes of intentional ingestion of foreign bodies (IFB) compared to unintentional foreign body ingestions and esophageal food impactions (UFI) at the University of Arizona Medical Center. Hospital billing data from 2006-2012 generated from relevant ICD-9 codes was utilized to identify potential cases of foreign body ingestion. Due to initial availability of the data, we analyzed cases from 2010-2011 and identified appropriate cases from a detailed review of hospital charts and electronic medical records. Total cost based on emergency room, procedural, and inpatient costs were calculated. Total hospital length of stay, concurrent medical or psychiatric issues, endoscopic findings, and documented reason for ingestion were also assessed. Results: From Jan 2010-Dec 2011, 20 cases, consisting of 13 patients met criteria for IFB, and 29 cases consisting of 27 patients, met criteria for UFI. Two patients had 3 intentional foreign body ingestions, and 4 patients had two episodes of IFB. Two patients had a second episode of UFI. 75% of the IFB cases (9 patients) were reported suicidal attempts and 10 of the 13 patients with intentional foreign body ingestions had a psychiatric disorder. 70.6% of IFB cases required hospitalization compared to 11.1% UFI cases. Average LOS was 2.5 days for IFB compared to 0.78 days for UFI. The average total cost of medical care for IFB was $208,668.95 compared to $11349.94 for UFI (p=0.03350) (see table 1). Conclusion: In this study, the cost associated with IFB were significantly higher than for UFI. Patients with IFB also had higher rates of hospitalization, longer average LOS, more repeat episodes, and were more likely to have psychiatric disorders compared to UFI. To decrease the costs associated with IFB, additional resources for prevention including psychiatric care may be beneficial.Table 1