Seguridad de la reducción del tiempo de reposo posbiopsia hepática percutánea y por vía laparoscópica

Nodarse-Pérez, Pablo Orlando; Pérez-Menéndez, Roberto; Heredia-Andrade, Enkly Dennys; Noa-Pedroso, Guillermo; Araluce-Cordoví, Roberto; Fernández-Sotolongo, José

doi:10.1016/j.circir.2015.09.006

Cited by 4 publications

(4 citation statements)

References 25 publications

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“…There was, however, an attributable median cost of US $992 per patient for children monitored overnight compared to same-day observation. Our data add to existing adult [22] and a growing body of pediatric literature [13] that reinforces the relative safety of ultrasound-guided PLB and a potential to yield a substantial economic impact by embracing same-day monitoring as standard practice for children without major comorbidities. Taken in sum, these data may assist in the development of pediatric guidelines for post PLB management including identification of ideal recovery durations and setting.…”

Section: Discussionsupporting

confidence: 56%

“…Although the greatest risk of bleeding occurs within the first few hours after biopsy, the optimal length of observation to mitigate delayed complications after PLB has not been established [12391221]. The American Association for the Study of Liver Diseases provided guidelines recommending a 2- to 4-hour observation period after PLB for adults undergoing outpatient biopsy [22122]. However, current guidelines permit significant variability regarding recovery duration after biopsy for children [811].…”

Section: Introductionmentioning

confidence: 99%

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Same-Day versus Overnight Observation after Outpatient Pediatric Percutaneous Liver Biopsy: A Retrospective Cohort Study

Kozlovich

Sochet

Son

et al. 2019

Pediatr Gastroenterol Hepatol Nutr

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Purpose Percutaneous liver biopsy (PLB), a diagnostic procedure to identify several hepatobiliary disorders, is considered safe with low incidence of associated complications. While postoperative monitoring guidelines are suggested for adults, selection of procedural recovery time for children remains at the discretion of individual operators. We aim to determine if differences exist in frequency of surgical complications, unplanned admissions, and healthcare cost for children undergoing outpatient PLB for cohorts with same-day vs. overnight observation. Methods We performed a retrospective cohort study in children 1 month to 17 years of age undergoing ultrasound-guided PLB from January 2009 to August 2017 at a tertiary care, pediatric referral center. Cohorts were defined by postprocedural observation duration: same-day (≤8 hours) vs. overnight observation. Outcomes included surgical complications, medical interventions, unscheduled hospitalization within 7 days, and total encounter costs. Results One hundred and twelve children met study criteria of which 18 (16.1%) were assigned to same-day observation. No differences were noted in demographics, anthropometrics, comorbidities, biopsy indications, or preoperative coagulation profiles. No major complications or acute hospitalizations after PLB were observed. Administration of analgesia and fluid boluses were isolated and given within 8 hours. Compared to overnight monitoring, same-day observation accrued less total costs (US $992 less per encounter). Conclusion Same-day observation after PLB in children appears well-tolerated with only minor interventions and complications observed within 8 hours of procedure. We recommend a targeted risk assessment prior to selection of observation duration. Same-day observation appears an appropriate recovery strategy in otherwise low-risk children undergoing outpatient PLB.

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Section: Discussionsupporting

confidence: 56%

Section: Introductionmentioning

confidence: 99%

Same-Day versus Overnight Observation after Outpatient Pediatric Percutaneous Liver Biopsy: A Retrospective Cohort Study

Kozlovich

Sochet

Son

et al. 2019

Pediatr Gastroenterol Hepatol Nutr

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“…Followed up with US and extended observation to 24 h if clinical signs. [solicited] Nodarse-Perez (2016), Cuba; Single center [ 51 ] RCT; 2011–2012; Not reported Elevated LFT (31%), Viral (28%), Cholestasis (8%), Metastasis (8%) Mean age 48–50 years; 44% male US-guided percutaneous Included: platelets ≥ 70,000, Quick’s test value ≥ 50%. Hgb l > 8 g/dL.…”

Section: Resultsmentioning

confidence: 99%

Incidence of Complications from Percutaneous Biopsy in Chronic Liver Disease: A Systematic Review and Meta-Analysis

et al. 2021

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Background Approaches to liver biopsy have changed over the past decade in patients with chronic liver disease. Aims We conducted a systematic review and meta-analysis on the incidence of all complications and technical failure associated with percutaneous liver biopsy. Methods We systematically searched PubMed and the Cochrane Library for cohort studies reporting on complications resulting from liver biopsy published between 2010 and 2020. Studies on participants of any age and sex, who underwent any percutaneous biopsy for non-focal liver disease, were selected. All events except mild pain, minor hematoma, vasovagal episodes, fever and fistula were defined as major complications. Random-effect model meta-analyses with and without covariates were performed, to examine the effect of publication year, patient characteristics, outcome collection, and biopsy type on incidences. Results We identified 30 studies reporting on complications resulting from percutaneous liver biopsy procedures (n = 64,356). Incidence of major complications was 2.44% (95% CI 0.85, 6.75), with mortality at 0.01% (95% CI 0.00, 0.11), hospitalization at 0.65% (95% CI 0.38, 1.11), major bleeding at 0.48% (95% CI 0.22, 1.06), and moderate/severe pain at 0.34% (95% CI 0.08, 1.37). Minor complications at 9.53% (95% CI 3.68, 22.5) were mainly pain at 12.9% (95% CI 5.34, 27.9). Technical failure was high at 0.91% (95% CI 0.27, 3.00). Decreasing patient age significantly increased incidence of hospitalization and major bleeding (P < 0.0001). Hospitalization incidence also significantly increased with disease severity. Conclusions Incidence of major (2.4%) and minor (9.5%) complications, and technical failure (0.91%) in percutaneous liver biopsies continues.

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“…There is limited data regarding shorted recovery times. Nodarse-Perez et al demonstrated in a randomized controlled clinical trial that there is no difference in complication rates between two hours and six hours post-liver biopsy [6]. In 2007, Beddy et al demonstrated that a one-hour post-liver biopsy recovery time was feasible and safe for most patients undergoing liver biopsy by interventional radiology [7].…”

Section: Introductionmentioning

confidence: 99%

One-hour Recovery Time in Subjects Undergoing Percutaneous Liver Biopsy: A Quality Improvement and Patient Safety Project

Liane

Dooley

Sarkar

et al. 2019

Cureus

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IntroductionLiver biopsy is the gold standard in diagnosing, staging and guiding clinical management in liver disease. There are currently no standard guidelines for liver biopsy recovery time. The aims of this project are to study the safety of a one-hour recovery time after percutaneous liver biopsies and to measure the rate of complications and identify risk factors.MethodsA total of 500 consecutive subjects who underwent a percutaneous liver biopsy at a single-center teaching institution (Brooke Army Medical Center) were enrolled between December 2016 and October 2018. Biopsies were performed using a 14-gauge Bard® Monopty® core biopsy needle using bedside ultrasound. Complications were defined as: Pain level > 5 out of 10, hospitalizations, emergency department visits, or other. Major complications were defined as: hospitalizations and emergency department visits.ResultsThe only complication that required hospitalization was identified during the first hour of recovery. Liver biopsies of subjects with body mass index (BMI) ≥35 kg/m2 were not associated with more complications when compared to patients less than 30 kg/m2. Using a spinal needle (3.5’’) to anesthetize the liver capsule in subjects with excess subcutaneous tissue did not result in more complications when compared to the standard 1.5’’ needle. Only 3% of the patients who received lidocaine alone for the biopsy required post-procedure medications.ConclusionUltrasound-guided percutaneous liver biopsies, using a 14-gauge needle, were overall found to be safe. A one-hour post recovery period is adequate to identify all immediate major complications.

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Seguridad de la reducción del tiempo de reposo posbiopsia hepática percutánea y por vía laparoscópica

Cited by 4 publications

References 25 publications

Same-Day versus Overnight Observation after Outpatient Pediatric Percutaneous Liver Biopsy: A Retrospective Cohort Study

Same-Day versus Overnight Observation after Outpatient Pediatric Percutaneous Liver Biopsy: A Retrospective Cohort Study

Incidence of Complications from Percutaneous Biopsy in Chronic Liver Disease: A Systematic Review and Meta-Analysis

One-hour Recovery Time in Subjects Undergoing Percutaneous Liver Biopsy: A Quality Improvement and Patient Safety Project

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