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Published on: March 25, 2022
Variability in perioperative evaluation and resource utilization in pediatric patients with suspected biliary
Sarah B Cairo1, Arturo Aranda2, Marisa Bartz-Kurycki3
1Department of Pediatric Surgery, John R Oishei Children's Hospital, Buffalo, NY.
Insights
Pediatric biliary dyskinesia (BD) diagnosis and treatment show significant variability. Non-white race and psychiatric comorbidities increase the risk of persistent symptoms after gallbladder removal.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Health Services Research
Background:
- Biliary dyskinesia (BD) is a frequent reason for pediatric cholecystectomy.
- Diagnosis relies on gallbladder ejection fraction (GB-EF), but pediatric work-up and management remain controversial.
Purpose of the Study:
- To compare perioperative work-up and outcomes in children undergoing cholecystectomy for BD across multiple institutions.
- To identify factors associated with persistent symptoms post-operatively.
Main Methods:
- Multi-institutional retrospective review of 678 pediatric patients undergoing cholecystectomy for BD.
- Analysis of patient demographics, pre-operative work-up, and post-operative outcomes.
- Multivariate analysis to identify risk factors for persistent symptoms.
Main Results:
- Significant variability observed in initial patient evaluation (pediatric surgeons, gastroenterologists, emergency department) and follow-up protocols across institutions (p < 0.001).
- Gallbladder ejection fraction (EF < 15%) was reported in 44.8% of patients.
- Post-operative symptoms persisted in 35.3% of patients; non-white race and psychiatric comorbidities were associated with increased risk.
Conclusions:
- Substantial variability exists in the pre- and post-operative evaluation and management of pediatric BD.
- Standardized data collection and prospective research are necessary to establish optimal care pathways for pediatric BD.
Introduction:
Biliary dyskinesia (BD) is a common indication for pediatric cholecystectomy. While diagnosis is primarily based on diminished gallbladder ejection fraction (GB-EF), work-up and management in pediatrics is controversial.
Methods:
We conducted a multi-institutional retrospective review of children undergoing cholecystectomy for BD to compare perioperative work-up and outcomes.
Results:
Six hundred seventy-eight patients across 16 institutions were included. There was no significant difference in gender, age, or BMI between institutions. Most patients were white (86.3%), non-Hispanic (79.9%), and had private insurance (55.2%). Gallbladder ejection fraction (EF) was reported in 84.5% of patients, and 44.8% had an EF <15%. 30.7% of patients were initially seen by pediatric surgeons, 31.3% by pediatric gastroenterologists, and 23.4% by the emergency department with significant variability between institutions (p < 0.001). Symptoms persisted in 35.3% of patients post-operatively with a median follow-up of 21 days (IQR 13, 34). On multivariate analysis, only non-white race and the presence of psychiatric comorbidities were associated with increased risk of post-operative symptoms.
Conclusion:
There is significant variability in evaluation and follow-up both before and after cholecystectomy for BD. Prospective research with standardized data collection and follow-up is needed to develop and validate optimal care pathways for pediatric patients with suspected BD.
Study Type:
Case Series, Retrospective Review.
Level Of Evidence:
Level IV.
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