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01-08-2018 | Original Article

Analysis of risk factors for morbidity in children undergoing the Kasai procedure for biliary atresia

Authors: Alejandro V. Garcia, Mitchell R. Ladd, Todd Crawford, Katherine Culbreath, Oswald Tetteh, Samuel M. Alaish, Emily F. Boss, Daniel S. Rhee

Published in: Pediatric Surgery International | Issue 8/2018

Abstract

Objective

To evaluate the perioperative risk factors for 30-day complications of the Kasai procedure in a large, cross-institutional, modern dataset.

Study design

The 2012–2015 National Surgical Quality Improvement Program Pediatric database was used to identify patients undergoing the Kasai procedure. Patients’ characteristics were compared by perioperative blood transfusions and 30-day outcomes, including complications, reoperations, and readmissions. Multivariable logistic regression was used to identify risk factors predictive of outcomes. Propensity matching was performed for perioperative blood transfusions to evaluate its effect on outcomes.

Results

190 children were included with average age of 62 days. Major cardiac risk factors were seen in 6.3%. Perioperative blood transfusions occurred in 32.1%. The 30-day post-operative complication rate was 15.8%, reoperation 6.8%, and readmission 15.3%. After multivariate analysis, perioperative blood transfusions (OR 3.94; p < 0.01) and major cardiac risk factors (OR 7.82; p < 0.01) were found to increase the risk of a complication. Perioperative blood transfusion (OR 4.71; p = 0.01) was associated with an increased risk of reoperation. Readmission risk was increased by prematurity (OR 3.88; p = 0.04) and 30-day complication event (OR 4.09; p = 0.01). After propensity matching, perioperative blood transfusion was associated with an increase in complications (p < 0.01) and length of stay (p < 0.01).

Conclusion

Major cardiac risk factors and perioperative blood transfusions increase the risk of post-operative complications in children undergoing the Kasai procedure. Further research is warranted in the perioperative use of blood transfusions in this population.

Level of evidence

IV.

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Sundaram SS, Mack CL, Feldman AG, Sokol RJ (2016) Biliary atresia: indications and timing of liver transplantation and optimization of pre-transplant care. Liver Transplant 23:96–109. https://doi.org/10.1002/lt.24640 CrossRef

Yoon PW, Bresee JS, Olney RS, James LM, Khoury MJ (1997) Epidemiology of biliary atresia: a population-based study. Pediatrics 99(3):376–382. http://www.ncbi.nlm.nih.gov/pubmed/9041292

Asai A, Miethke A, Bezerra J (2015) Pathogenesis of biliary atresia: defining biology to understand clinical phenotypes. Nat Rev Gastroenterol Hepatol 12(6):342–352. https://doi.org/10.1038/nrgastro.2015.74 CrossRefPubMedPubMedCentral

Sokol RJ, Mack C (2001) Etiopathogenesis of biliary atresia. Semin Liver Dis 21(4):517–524CrossRefPubMed

Mack C (2007) The pathogenesis of biliary atresia: evidence for a virus induced-autoimmune disease. Semin Liver Dis 27(3):233–242CrossRefPubMedPubMedCentral

Schreiber RA, Kleinman RE (1993) Editorial genetics, Immunology, and biliary atresia: an oppening or a diversion? J Pediatr Gastroenterol Nutr 16(2):111–113CrossRefPubMed

Bezerra JA (2005) Potential etiologies of biliary atresia. Pediatr Transplant 9(5):646–651CrossRefPubMed

Garcia AV, Cowles RA, Kato T, Hardy MA (2012) Morio Kasai: a remarkable impact beyond the Kasai procedure. J Pediatr Surg 47(5):1023–1027. https://doi.org/10.1016/j.jpedsurg.2012.01.065 CrossRefPubMedPubMedCentral

Lee JY, Lim LTK, Quak SH, Prabhakaran K, Aw M (2014) Cholangitis in children with biliary atresia: health-care resource utilisation. J Paediatr Child Health 50(3):196–201CrossRefPubMed

10.

Piatt JH (2014) Thirty-day outcomes of cerebrospinal fluid shunt surgery: data from the National Surgical Quality Improvement Program-Pediatrics. J Neurosurg Pediatr 14(2):179–183. http://www.ncbi.nlm.nih.gov/pubmed/24926972

11.

Martin CT, Pugely AJ, Gao Y, Ilgenfritz RM, Weinstein SL (2014) Incidence and risk factors for early wound complications after spinal arthrodesis in children. Spine (Phila Pa 1976) 39(18):1463–1470. http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00007632-201408150-00008

12.

Skarsgard ED, Bedford J, Chan T, Whyte S, Afshar K (2014) ACS national surgical quality improvement program: targeting quality improvement in Canadian pediatric surgery. J Pediatr Surg 49(5):682–687. https://doi.org/10.1016/j.jpedsurg.2014.02.047 CrossRefPubMed

13.

Shah R, Md MB, Stey A, Md MS, Jatana K et al (2014) Identification of opportunities for quality improvement and outcome measurement in pediatric otolaryngology. JAMA Otolaryngol Head Neck Surg 140(11):1019–1026. http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=ovftp&NEWS=N&AN=01714642-201411000-00005

14.

Roxbury CR, Yang J, Salazar J, Shah RK, Boss EF (2015) Safety and postoperative adverse events in pediatric otologic surgery: analysis of American College of Surgeons NSQIP-P 30-day outcomes. Otolaryngol Head Neck Surg 152(5):790–795CrossRefPubMed

15.

Roxbury CR, Jatana KR, Shah RK, Boss EF (2016) Safety and postoperative adverse events in pediatric airway reconstruction: analysis of ACS-NSQIP-P 30-day outcomes. Laryngoscope 127:504–508CrossRefPubMed

16.

Raval MV, Dillon PW, Bruny JL, Ko CY, Hall BL, Moss RL et al (2011) American College of Surgeons national surgical quality improvement program pediatric: a phase 1 report. J Am Coll Surg 212(1):1–11CrossRefPubMed

17.

Serinet M-O, Wildhaber BE, Broué P, Lachaux A, Sarles J, Jacquemin E et al (2009) Impact of age at Kasai operation on its results in late childhood and adolescence: a rational basis for biliary atresia screening. Pediatrics 123(5):1280–1286. http://www.ncbi.nlm.nih.gov/pubmed/19403492

18.

Oski F, Naiman J (1982) Hematologic problems in the newborn infant, 3rd edn. W.B. Saunders, Philadelphia

19.

Nathan DG, Oski FA (1998) Hematology of infancy and childhood, 5th edn. In: Nathan DG, Oski FA (eds) W.B. Saunders, Philadelphia

20.

Engorn B, Flerlage J (2015) The Harriet lane handbook, 20th edn. In: Engorn B, Flerlage J (eds) Elsevier Saunders, Philadelphia

21.

Costa K (2018) Hematology. In: Hughes HK, Kahl LK (eds) The Harriet lane handbook, 21st edn. Elsevier, Philadelphia, pp 364–394

22.

Fawley J, Chelius TH, Anderson Y, Cassidy LD, Arca MJ (2016) Relationship between perioperative blood transfusion and surgical site infections in the newborn population: an ACS-NSQIP-pediatrics analysis. J Pediatr Surg 51(9):1397–1404. https://doi.org/10.1016/j.jpedsurg.2016.05.010 CrossRefPubMed

23.

Keir AK, McPhee AJ, Andersen CC, Stark MJ (2013) Plasma cytokines and markers of endothelial activation increase after packed red blood cell transfusion in the preterm infant. Pediatr Res 73(1):75–79CrossRefPubMed

24.

Shneider BL, Brown MB, Haber B, Whitington PF, Schwarz K, Squires R et al (2006) A multicenter study of the outcome of biliary atresia in the United States, 1997 to 2000. J Pediatr 148(4):467–474CrossRefPubMed

25.

Balistreri WF, Bezerra JA (2006) Whatever happened to “neonatal hepatitis”? Clin Liver Dis 10(1):27–53CrossRefPubMed

26.

Altman RP, Lilly JR, Greenfeld J, Weinberg A, van Leeuwen K, Flanigan L (1997) A multivariable risk factor analysis of the portoenterostomy (Kasai) procedure for biliary atresia: twenty-five years of experience from two centers. Ann Surg 226(3):348–353 (discussion 353–355)CrossRefPubMedPubMedCentral

27.

Nio M (2017) Japanese Biliary Atresia Registry. Pediatr Surg Int 33(12):1319–1325. https://doi.org/10.1007/s00383-017-4160-x CrossRefPubMed

28.

Nio M, Ohi R, Miyano T, Saeki M, Shiraki K, Tanaka K (2003) Five- and 10-year survival rates after surgery for biliary atresia: a report from the Japanese Biliary Atresia Registry. J Pediatr Surg 38(7):997–1000CrossRefPubMed

29.

Davenport M, Caponcelli E, Livesey E, Hadzic N, Howard E (2008) Surgical outcome in biliary atresia. Ann Surg 247(4):694–698. http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00000658-200804000-00018

30.

Bucher BT, Duggan EM, Grubb PH, France DJ, Lally KP, Blakely ML (2016) Does the American College of Surgeons National Surgical Quality Improvement Program pediatric provide actionable quality improvement data for surgical neonates? J Pediatr Surg 51(9):1440–1444. https://doi.org/10.1016/j.jpedsurg.2016.02.084 CrossRefPubMed

Title: Analysis of risk factors for morbidity in children undergoing the Kasai procedure for biliary atresia
Authors: Alejandro V. Garcia
Mitchell R. Ladd
Todd Crawford
Katherine Culbreath
Oswald Tetteh
Samuel M. Alaish
Emily F. Boss
Daniel S. Rhee
Publication date: 01-08-2018
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Surgery International / Issue 8/2018
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-018-4298-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Analysis of risk factors for morbidity in children undergoing the Kasai procedure for biliary atresia

Abstract

Objective

Study design

Results

Conclusion

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Study design

Results

Conclusion

Level of evidence

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