Jordan C Apfeld1, Jennifer N Cooper1, Yuri V Sebastião1, Greg M Tiao2, Peter C Minneci3, Katherine J Deans4. 1. Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 611 Livingston Avenue, Suite 3A.3, Columbus, OH 43205, United States; Center for Innovation in Pediatric Practice, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States. 2. Department of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, United States. 3. Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 611 Livingston Avenue, Suite 3A.3, Columbus, OH 43205, United States; Center for Innovation in Pediatric Practice, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States; Department of Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States. 4. Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 611 Livingston Avenue, Suite 3A.3, Columbus, OH 43205, United States; Center for Innovation in Pediatric Practice, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States; Department of Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States. Electronic address: Katherine.Deans@nationwidechildrens.org.
Abstract
BACKGROUND/ PURPOSE: The purpose of this study was to assess variability in age at Kasai portoenterostomy (KP) in infants with biliary atresia (BA) across children's hospitals in the United States. STUDY DESIGN: A multi-institutional retrospective study was performed examining infants with BA undergoing KP within 6 months of birth from 2016-2019, utilizing the Pediatric Health Information System (PHIS). Multivariable negative binomial mixed effects regression was performed for age at KP, and inter-hospital variability was examined. RESULTS: Across 46 hospitals, 470 infants with BA underwent KP at a median age of 57 days (IQR 42-72), with 212 (45.1%) undergoing KP at ≥60 days of age. There was significant inter-hospital variability in age at KP ranging from 38 days (95% CI: 31d, 47d) to 76 days (95% CI: 63d, 91d) (p<0.0001). Factors associated with later KP were black or African-American race, urgent/emergent admission, and treatment at a hospital in the Pacific-West region. Predictors of earlier KP included later year, history of neonatal comorbidity, and admission to an intensive care service (all p<0.05). CONCLUSION: There is significant variability in the age at KP in infants with BA across children's hospitals in the United States. TYPE OF STUDY: Retrospective study. LEVEL OF EVIDENCE: III.
BACKGROUND/ PURPOSE: The purpose of this study was to assess variability in age at Kasai portoenterostomy (KP) in infants with biliary atresia (BA) across children's hospitals in the United States. STUDY DESIGN: A multi-institutional retrospective study was performed examining infants with BA undergoing KP within 6 months of birth from 2016-2019, utilizing the Pediatric Health Information System (PHIS). Multivariable negative binomial mixed effects regression was performed for age at KP, and inter-hospital variability was examined. RESULTS: Across 46 hospitals, 470 infants with BA underwent KP at a median age of 57 days (IQR 42-72), with 212 (45.1%) undergoing KP at ≥60 days of age. There was significant inter-hospital variability in age at KP ranging from 38 days (95% CI: 31d, 47d) to 76 days (95% CI: 63d, 91d) (p<0.0001). Factors associated with later KP were black or African-American race, urgent/emergent admission, and treatment at a hospital in the Pacific-West region. Predictors of earlier KP included later year, history of neonatal comorbidity, and admission to an intensive care service (all p<0.05). CONCLUSION: There is significant variability in the age at KP in infants with BA across children's hospitals in the United States. TYPE OF STUDY: Retrospective study. LEVEL OF EVIDENCE: III.
Authors: Lorraine I Kelley-Quon; Eveline Shue; Rita V Burke; Caitlin Smith; Karen Kling; Elaa Mahdi; Shadassa Ourshalimian; Michael Fenlon; Matthew Dellinger; Stephen B Shew; Justin Lee; Benjamin Padilla; Thomas Inge; Jonathan Roach; Ahmed I Marwan; Katie W Russell; Romeo Ignacio; Elizabeth Fialkowski; Amar Nijagal; Cecilia Im; Kenneth S Azarow; Daniel J Ostlie; Kasper Wang Journal: Pediatr Surg Int Date: 2021-12-02 Impact factor: 1.827