Trends in age for hepatoportoenterostomy in the United States
Mehul V Raval1, Alexander Dzakovic, David J Bentrem
1Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL 60611-3211, USA. m-raval@md.northwestern.edu
Insights
Early hepatoportoenterostomy is crucial for biliary atresia outcomes, but surgery age has not improved in two decades. Hospital and socioeconomic factors significantly impact timely diagnosis and treatment for this rare liver disease.
Area of Science:
- Pediatric Surgery
- Hepatology
- Public Health
Background:
- Biliary atresia is a rare, severe liver disease in infants.
- Hepatoportoenterostomy is the primary surgical treatment.
- Delayed surgery correlates with poorer patient outcomes.
Purpose of the Study:
- To analyze trends in the age of hepatoportoenterostomy for biliary atresia.
- To identify patient and hospital factors influencing the timing of surgery.
Main Methods:
- Utilized the Kids' Inpatients Database (1997-2006).
- Compared median ages of patients undergoing hepatoportoenterostomy.
- Analyzed demographic and hospital characteristics associated with treatment delay.
Main Results:
- The median age for hepatoportoenterostomy remained unchanged (around 65 days) from 1997 to 2006.
- Treatment at non-children's hospitals was linked to delayed surgery (OR 3.5, P=.02).
- Hispanic and African American patients showed a trend towards later surgery compared to white patients.
Conclusions:
- Despite the importance of early intervention, significant improvements in the median age at hepatoportoenterostomy have not been observed.
- Both hospital-type and socioeconomic factors contribute to delays in biliary atresia treatment.
- Further research is needed to address disparities and improve timely surgical care for biliary atresia.
Background:
Biliary atresia is a rare but devastating disease for which hepatoportoenterostomy remains the primary intervention. Increased age at the time of hepatoportoenterostomy is associated with unfavorable outcomes. In this study, we examined trends in age at the time of hepatoportoenterostomy and explored hospital and patient factors associated with more timely diagnosis and treatment.
Methods:
Median ages of patients undergoing hepatoportoenterostomy for biliary atresia were compared using the Kids' Inpatients Database from 1997, 2000, 2003, and 2006. The patient and hospital factors associated with later treatment were compared.
Results:
Of 192 patients, 13.5% had surgery in 1997, 13.5% in 2000, 36.5% in 2003, and 36.5% in 2006. The overall median age was 65.5 days; the median age was 64 days in 1997, 57.5 days in 2000, 69 days in 2003, and 64 days in 2006 (P = .80). Overall, 71% of patients were treated at nonchildren's hospitals, and although the proportion has increased over time, the trend did not reach significance (P = .12). Hispanic and African American patients were more likely to undergo hepatoportoenterostomy after 60 days of life compared with white patients (Hispanic patients: odds ratio, 3.6; 95% confidence interval, 1.1-12.5; P = .04; African American patients: odds ratio, 2.2; 95% confidence interval, 0.8-6.3; P = .14). Compared with specialized children's centers, treatment at nonchildren's hospitals was associated with delayed hepatoportoenterostomy (odds ratio, 3.5; 95% confidence interval, 1.2-9.8; P = .02).
Conclusion:
Although early hepatoportoenterostomy is associated with improved outcomes for children with biliary atresia, our study shows the median age at surgery has not significantly changed over 2 decades. Both hospital and socioeconomic factors play a role in the early treatment of biliary atresia.
