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

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.

Keywords: Biliary atresia; Congenital anomaly; Kasai portoenterostomy; Neonatal jaundice; Pediatric surgery; Variability.