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

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Pediatric Surgery International Aims and scope Submit manuscript

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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Abbreviations

BA:

Biliary atresia

NSQIP-P:

National Surgical Quality Improvement Program-Pediatric

GI:

Gastrointestinal

SIRS:

Systemic inflammatory response syndrome

LOS:

Length of stay

POD:

Post-operative day

SSI:

Surgical site infections

UTI:

Urinary tract infections

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Funding

EFB is supported by Grant number K08HS022932 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality. MRL received salary support during his contribution to this study under a National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases T32 training grant (2T32DK007713-21).

Author information

Authors and Affiliations

  1. Department of Surgery, Johns Hopkins School of Medicine, 1800 Orleans St., Baltimore, MD, 21287, USA

    Alejandro V. Garcia, Mitchell R. Ladd, Todd Crawford, Katherine Culbreath, Oswald Tetteh, Samuel M. Alaish & Daniel S. Rhee

  2. Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA

    Emily F. Boss

Authors
  1. Alejandro V. Garcia
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  2. Mitchell R. Ladd
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  3. Todd Crawford
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  4. Katherine Culbreath
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  5. Oswald Tetteh
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  6. Samuel M. Alaish
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  7. Emily F. Boss
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  8. Daniel S. Rhee
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Corresponding author

Correspondence to Alejandro V. Garcia.

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Conflict of interest

The authors declare that they have no conflicts of interest to disclose.

Ethical approval

This study involving human participants was in accordance with the ethical standards of our institutional review board and with the 1964 Helsinki declaration and its later amendments or compatible ethical standards. In particular, this study was approved by our institutional review board under the study number IRB00077777. For this type of study formal consent is not required.

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For this type of study formal consent is not required.

Appendix

Appendix

See Table 5.

Table 5 Hematocrit values to define anemia
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Garcia, A.V., Ladd, M.R., Crawford, T. et al. Analysis of risk factors for morbidity in children undergoing the Kasai procedure for biliary atresia. Pediatr Surg Int 34, 837–844 (2018). https://doi.org/10.1007/s00383-018-4298-1

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  • DOI: https://doi.org/10.1007/s00383-018-4298-1

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