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Swallowed Foreign Objects Cost $2M at RI Hospital

 |  By John Commins  
   November 03, 2010

A Rhode Island Hospital report shows that 33 patients needed 305 medical interventions to remove foreign objects, including knives, razor blades, and batteries that were intentionally swallowed, resulting in more than $2 million in hospital costs over eight years.

The findings appear in the November issue of Clinical Gastroenterology and Hepatology.

Through a retrospective case study, the most common items were pens (24%), batteries (9%), knives (7%) and razor blades (7%). Most of the removals were successful during the initial endoscopic extraction except for 20 cases. Two cases eventually required a surgical extraction. The 305 cases involved 33 patients, of which 79% were previously diagnosed with a psychiatric disorder.

"Intentional foreign body ingestion occurs among a relatively small number of patients with psychiatric disorders and is costly," says Steven Moss, MD, in a statement.  Moss is a gastroenterologist at RIH, and lead author of the study. "While endoscopic retrieval is relatively safe and effective, it often requires general anesthesia and utilizes significant hospitals resources."

In 237 cases, the foreign objects were retrieved most commonly from the stomach or esophagus. Complications arose in 10 cases and surgical consultations were required. There were no cases of perforations or patient deaths. Hospital costs incurred in the patients' care from these 305 cases totaled $2,018,073, paid primarily by Medicare/Medicaid. The biggest cost drivers were nursing care (56%), followed by endoscopy, emergency department, and surgical services.

"Our study shows that intentional ingestion of foreign bodies is a relatively common event at our hospital. Intentional, rather than accidental, swallowing is a poorly recognized and underappreciated problem which is potentially avoidable," Moss said. 

Moss said 58% of the patients were male, and the mean age for the patients at the time of ingestion was 35. One patient was responsible for 67 of the 305 cases, and four patients accounted for 179 cases. Fifty-three percent of the patients were admitted from residential institutions, mostly from a state-run chronic psychiatric inpatient facility. Thirty-eight percent of the patients were from private homes, and 9% were from prison.

More than half of the patients were diagnosed with a mood disorder, while others suffered from anxiety, substance abuse, psychotic or impulse control disorders.

"The reasons for foreign body ingestion vary and it is one of many forms of self-injurious behavior. Foreign body ingestion can be a behavioral element of cognitive disorders, mental retardation syndromes, psychotic disorders, and mood disorders," said co-author Colin Harrington, MD, a psychiatrist at RIH. "Various personality disorder diagnoses are also associated with foreign body ingestion where motivations are thought to include communication of internal distress, acting out due to anger, or even manipulation of the environment with a related secondary gain, such as transfer out of chronic institutional settings like prison or long-term treatment facilities."

Harrington said most cases of foreign object ingestion do not represent suicide attempts and that "repetitive foreign body ingestion occurs in a very small group of patients and is typically difficult to treat and prevent."

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

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