Steroid use after the Kasai procedure for biliary atresia
Oliver B Lao1, Cindy Larison, Michelle Garrison
1Department of Surgery, Seattle Children's Hospital, Seattle, WA, USA. olao@uw.edu
Insights
Systemic steroid use in pediatric patients undergoing the Kasai procedure for biliary atresia was associated with a shorter hospital stay. Further research is needed to confirm this finding for Kasai procedure outcomes.
Area of Science:
- Pediatric Surgery
- Hepatology
- Clinical Outcomes Research
Background:
- Biliary atresia is a rare liver disease in infants.
- The Kasai procedure is a surgical intervention for biliary atresia.
- Outcomes and treatment associations require further investigation.
Purpose of the Study:
- To describe patients who underwent the Kasai procedure.
- To evaluate the outcomes of the Kasai procedure.
- To analyze the association between systemic steroid use and outcomes.
Main Methods:
- Retrospective analysis of the Pediatric Health Information System database (2003-2008).
- Inclusion of biliary atresia patients (ICD-9 751.61) who underwent the Kasai procedure.
- Regression analyses to assess the impact of postoperative steroid use on length of stay, mortality, and cholangitis.
Main Results:
- 516 pediatric patients were identified.
- 46% of patients received perioperative steroids.
- Postoperative steroid use was linked to a 3.5-day reduction in postoperative length of stay.
Conclusions:
- Perioperative steroid administration is associated with a shorter postoperative hospital stay after the Kasai procedure.
- The causal relationship between steroids and reduced length of stay warrants further investigation.
Background:
The aim of this study was to describe patients undergoing the Kasai procedure at children's hospitals, evaluate outcomes, and analyze the association of these outcomes with systemic steroid use.
Methods:
Biliary atresia patients (International Classification of Diseases, Ninth Revision, code 751.61) who underwent Kasai procedures at freestanding children's hospitals in the Pediatric Health Information System database from 2003 to 2008 were identified. Descriptive characteristics were examined, and regression analyses were used to determine whether postoperative steroid use was associated with length of stay, mortality, or cholangitis.
Results:
Of the 516 children identified (40% male, 50% aged < 2 months), 239 (46%) received perioperative steroids. The mean total and postoperative lengths of stay were 14.5 +/- 19.7 and 11.3 +/- 16.3 days, respectively. Postoperative steroid use was significantly associated with a 3.5-day decrease in postoperative length of stay (95% confidence interval, .03-6.97).
Conclusions:
Perioperative steroids after the Kasai procedure are associated with shorter postoperative length of stay. Work is needed to ascertain whether this relationship is causal.
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