Real-world Multi-institutional Data From the Midwest Pediatric Surgery Consortium (MWPSC) to Assess the Effect of Delayed Kasai Procedure on Biliary Drainage in Patients With Biliary Atresia

IF 2.4 2区医学 Q1 PEDIATRICS

Journal of pediatric surgery Pub Date : 2025-02-18 DOI:10.1016/j.jpedsurg.2025.162250

Zishaan A. Farooqui , Stephen J. Hartman , Alyssa E. Stetson , Emily J. Schepers , Karen E. Speck , Samir K. Gadepalli , Kyle J. Van Arendonk , Christina Georgeades , Dave R. Lal , Katherine J. Deans , Peter C. Minneci , Jordan C. Apfeld , Jacqueline M. Saito , Grace Z. Mak , Mark B. Slidell , Caroline Lemoine , Riccardo Superina , Tiffany N. Wright , Cynthia D. Downard , Lekha P. Devara , Gregory M. Tiao

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引用次数: 0

Abstract

Purpose

Early Kasai portoenterostomy (KPE) for infants with biliary atresia (BA) increases the chance of transplant-free survival (TFS). However, early timing of KPE is not consistently achieved in the United States. Clearance of jaundice at three months is predictive of TFS. Among a cohort of patients with BA, we investigated institutional variability in the initiation of hyperbilirubinemia evaluation and operative timing to identify factors associated with successful jaundice clearance.

Methods

A multi-institutional, retrospective study was performed at eleven U.S. tertiary children’s hospitals. Infants diagnosed with BA between 10/1/2015–10/1/2020 were identified. Age at initiation of diagnostic workup and age at KPE were collected. Adjusted multivariable logistic regression was used to determine factors associated with direct bilirubin normalization at three months following KPE.

Results

In 161 infants, the median age at initiation of jaundice evaluation was 35 days (IQR 8–60). Among 148 patients who underwent KPE, median age at surgery was 53 days (IQR 37.3–67.5). Each 10-day increase in age at KPE was associated with a 18.8 % decrease in odds of normalizing bilirubin at three months (OR 0.81, 95 % CI 0.66–0.99), with infants who underwent KPE ≤50 days significantly more likely to normalize bilirubin (OR 2.6, CI 1.1–6.1) compared to KPE >50 days. There was significant variation among institutions in the time from initiation of workup to KPE (range 0–24.5 days, p = 0.02) and the odds of patients normalizing direct bilirubin at three months (range 0.04–0.89, p = 0.044).

Conclusion

Our results confirmed that increasing age at KPE decreases the odds of clearing bilirubin at three months post-KPE. We identified significant institutional variability in the time from workup to KPE that may have impacted the likelihood of successful biliary drainage.

Level of Evidence

IV (Well-designed case–control or cohort study).

查看原文本刊更多论文

来自中西部儿科外科联盟（MWPSC）的真实世界多机构数据评估延迟Kasai手术对胆道闭锁患者胆道引流的影响

目的早期开赛门肠造口术（KPE）治疗胆道闭锁（BA）婴儿可增加无移植生存（TFS）的机会。然而，在美国，KPE的早期时机并不一致。3个月时黄疸清除可预测TFS。在一组BA患者中，我们研究了高胆红素血症开始评估和手术时机的机构差异，以确定与黄疸成功清除相关的因素。方法对美国11所三级儿童医院进行多机构回顾性研究。在2015年10月1日至2020年10月1日期间诊断为BA的婴儿被确定。收集诊断检查开始时的年龄和KPE时的年龄。采用调整后的多变量logistic回归来确定与KPE后三个月胆红素直接正常化相关的因素。结果在161例婴儿中，黄疸开始评估的中位年龄为35天（IQR 8 ~ 60）。在148例接受KPE的患者中，手术时的中位年龄为53天（IQR为37.3-67.5）。KPE年龄每增加10天，三个月时胆红素正常化的几率降低18.8% (OR 0.81, 95% CI 0.66-0.99)，与KPE≥50天的婴儿相比，KPE≤50天的婴儿胆红素正常化的可能性更大（OR 2.6, CI 1.1-6.1）。从开始检查到KPE的时间（范围0-24.5天，p = 0.02）和患者在三个月时直接胆红素正常化的几率（范围0.04-0.89,p = 0.044）在不同机构之间存在显著差异。结论我们的研究结果证实，KPE年龄的增加降低了KPE后3个月胆红素清除的几率。我们发现，从检查到KPE的时间存在显著的制度差异，这可能会影响胆道引流成功的可能性。证据水平eiv（设计良好的病例对照或队列研究）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of pediatric surgery 医学-外科

CiteScore

1.10

自引率

12.50%

发文量

569

审稿时长

38 days

期刊介绍： The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical techniques, but also by attention to the unique emotional and physical needs of the young patient.