Cholangitis in children with biliary atresia: health-care resource utilisation
Jie Ying Lee1, Leon Tak Keet Lim, Seng Hock Quak
1Yong Loo Lin, School of Medicine, , National University of Singapore, Singapore, Singapore.
Insights
Cholangitis is a frequent complication in children with biliary atresia post-Kasai portoenterostomy. This study details common pathogens, high healthcare utilization, and significant costs associated with cholangitis episodes.
Area of Science:
- Pediatric Surgery
- Hepatology
- Infectious Diseases
Background:
- Cholangitis is a significant complication following Kasai portoenterostomy in biliary atresia patients.
- It contributes to increased morbidity, mortality, and healthcare resource utilization.
Purpose of the Study:
- To identify common causative organisms of cholangitis in children with biliary atresia.
- To characterize the burden, healthcare resource utilization, and cost of cholangitis.
Main Methods:
- Retrospective chart review of pediatric patients who underwent Kasai portoenterostomy (1988-2011).
- Causative organisms identified via culture reports.
- Disease burden, healthcare utilization, and costs were analyzed from institutional data.
Main Results:
- 64.3% of patients experienced at least one cholangitis episode, totaling 97 episodes.
- Common pathogens included Klebsiella pneumoniae, Enterococcus, Escherichia coli, and Pseudomonas aeruginosa.
- Average length of stay was 14.8 days per episode, with an estimated cost of $US 7369.02 per admission.
Conclusions:
- Understanding cholangitis incidence and costs aids in parental counseling for newly diagnosed biliary atresia.
- This knowledge supports better emotional and financial preparation for affected families.
Aim:
Cholangitis is a well-known complication that contributes to morbidity, mortality, as well as health-care utilisation in children with biliary atresia who have undergone the Kasai portoenterostomy. The aim of the study was to determine the common causative organisms for cholangitis and characterise its burden, health-care resource and service utilisation and cost.
Methods:
This was a retrospective chart review of children who underwent Kasai portoenterostomy in our institution from 1988 to 2011. The causative organisms were identified based on culture reports. The burden of the disease was estimated based on the number of patients experiencing one or more episodes of cholangitis. Health-care resource and service utilisation were based on different categories, and cost was computed based on the charges at the institution.
Results:
Twenty-seven (64.3%) out of 42 children included in the analysis experienced at least one episode of cholangitis. There were a total of 97 episodes of cholangitis, with an average of 3.6 (1-15) episodes per patient. The average length of stay per episode of cholangitis was 14.8 (2-64) days. Common organisms isolated during blood cultures were Klebsiella pneumoniae, Enterococcus, Escherichia coli and Pseudomonas aeruginosa. The estimated cost per in-patient admission of 15 days (rounded off) for a single episode of cholangitis was $SG 8986.61 ($US 7369.02).
Conclusion:
The knowledge about the incidence and cost of cholangitis will allow physicians to counsel parents of children newly diagnosed with biliary atresia and to better prepare them both emotionally and financially for what to expect.
