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Standard management protocol to improve the short-term outcome of biliary atresia
Patrick Hy Chung1, Kenneth Ky Wong1, Paul Kh Tam1
1Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.
Aim:
This study compared the outcomes of patients with biliary atresia (BA) treated according to a standardised protocol with historical patients.
Methods:
This is a single-centred retrospective study of BA patients treated from 1980 to 2016. A standardised treatment protocol was established since 2008 regarding peri-operative management. The outcomes being compared between the two groups (Groups I and II = before and after 2008, respectively) were jaundice clearance (JC), incidence of recurrent cholangitis, hospital admission and native liver survival (NLS).
Results:
A total of 128 patients were included (Group I = 100, Group II = 28). The overall median follow-up period was 15.3 years (I vs. II = 20.6 years vs. 5.1 years, respectively). There was no significant difference in the JC at the sixth month between the two groups (I vs. II = 60.0 vs. 82.1%, respectively, P = 0.07). The incidence of recurrent cholangitis was similar between the two groups (I vs. II = 39 vs. 35.7%, respectively, P = 0.45), but the median hospital admission episode per patient was non-significantly higher in Group I (I vs. II = 4.2 vs. 2.7, respectively, P = 0.08). There was an improvement in the 1-year NLS rate in Group II (I vs. II = 69.0 vs. 85.7%, respectively, P = 0.05).
Conclusions:
The introduction of a standardised management protocol has improved the short-term outcome of BA patients, with a better 1-year NLS observed.
