Variability in age at Kasai portoenterostomy for biliary atresia across US children's hospitals

Apfeld, Jordan C.; Cooper, Jennifer N.; Sebastião, Yuri V.; Tiao, Greg; Minneci, Peter C.; Deans, Katherine J.

doi:10.1016/j.jpedsurg.2021.02.027

Cited by 4 publications

(2 citation statements)

References 37 publications

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“…Considerable variability in age at KP for biliary atresia has been noted in United States children's hospitals [22]. In the present study, age at time of KP was the strongest predictor of TFS.…”

Section: Discussionsupporting

confidence: 48%

The need for early Kasai portoenterostomy: a Western Pediatric Surgery Research Consortium study

et al. 2021

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Purpose The purpose of this study was to investigate factors impacting transplant-free survival among infants with biliary atresia. Methods A multi-institutional, retrospective cohort study was performed at nine tertiary-level children's hospitals in the United States. Infants who underwent Kasai portoenterostomy (KP) from January 2009 to May 2017 were identified. Clinical characteristics included age at time of KP, steroid use, surgical approach, liver pathology, and surgeon experience. Likelihood of transplant-free survival (TFS) was evaluated using logistic regression, adjusting for patient and surgeon-level factors. Secondary outcomes at 1 year included readmission, cholangitis, reoperation, mortality, and biliary clearance. Results Overall, 223 infants underwent KP, and 91 (40.8%) survived with their native liver. Mean age at surgery was 63.9 days (± 24.7 days). At 1 year, 78.5% experienced readmission, 56.9% developed cholangitis, 3.8% had a surgical revision, and 5 died. Biliary clearance at 3 months was achieved in 76.6%. Controlling for patient and surgeon-level factors, each additional day of age toward operation was associated with a 2% decrease in likelihood of TFS (OR 0.98, 95% CI 0.97-0.99). Conclusion Earlier surgical intervention by Kasai portoenterostomy at tertiary-level centers significantly increases likelihood for TFS. Policy-level interventions to facilitate early screening and surgical referral for infants with biliary atresia are warranted to improve outcomes.

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Section: Discussionsupporting

confidence: 48%

The need for early Kasai portoenterostomy: a Western Pediatric Surgery Research Consortium study

et al. 2021

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“…Compared to the Caucasian group, the minority populations were at high risk of not undergoing the Kasai procedure. A study by Apfeld et al showed that African Americans undergo the Kasai procedure at a later age, which attenuates our results of this vulnerable population undergoing the procedure [ 24 ]. Those without private insurance were also less likely to undergo the procedure, the odds being 62% less in those without insurance.…”

Section: Discussionmentioning

confidence: 77%

Hospital Utilization, Treatment Modalities, and Mortality Using Different Biopsy Methods in Infants With Biliary Atresia

Mittal¹,

Kahlam²,

Le³

et al. 2022

Cureus

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Objectives To present a nationwide retrospective analysis of the sequelae and aftereffects of different liver biopsy methods in the care of pediatric patients with biliary atresia. Methods The National Inpatient Sample 2001-2013 database was queried for a primary diagnosis of biliary atresia and stratified based on biopsy type including percutaneous, surgical, laparoscopic, and transjugular. Patient demographics, length of stay, hospital costs, type of treatment, and mortality were compared by biopsy type. One-way analysis of variance test and multivariable logistic regression were used for analysis with α < 0.05. Results A total of 4,306 patients with biliary atresia were identified, of whom 2,293 underwent no biopsy, and 723 and 1,080 underwent a percutaneous or surgical biopsy, respectively. Significant differences in socio-demographics were demonstrated between the biopsy types. The length of stay and hospital charges were statistically significantly different between the biopsy types where patients without biopsies had the smallest length compared to percutaneous, surgical, and combination of biopsies. Overall, the Kasai procedure was done more frequently compared to direct liver transplantation, and compared to other biopsy types, undergoing a combination of biopsies had the highest odds of undergoing either procedure. Conclusions When comparing different biopsy methods, surgical biopsies of the liver outperformed percutaneous biopsies in hospital utilization and progression to definitive treatments with the Kasai procedure. Our research indicated that vulnerable populations such as minorities or the indigent may undergo inferior treatments or infrequently undergo definitive treatment. The need for definitive diagnostic guidelines is understated in patients with biliary atresia.

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A Pilot Study for Biliary Atresia Diagnosis: Fluorescent Imaging of Indocyanine Green in Stool

Lim,

Mutore,

Bradd

et al. 2024

Journal of Pediatric Surgery

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Variability in age at Kasai portoenterostomy for biliary atresia across US children's hospitals

Cited by 4 publications

References 37 publications

The need for early Kasai portoenterostomy: a Western Pediatric Surgery Research Consortium study

The need for early Kasai portoenterostomy: a Western Pediatric Surgery Research Consortium study

Hospital Utilization, Treatment Modalities, and Mortality Using Different Biopsy Methods in Infants With Biliary Atresia

A Pilot Study for Biliary Atresia Diagnosis: Fluorescent Imaging of Indocyanine Green in Stool

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