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Hospital Utilization, Treatment Modalities, and Mortality Using Different Biopsy Methods in Infants With Biliary
Anmol Mittal1, Aaron Kahlam1, Alexander Le1
1Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA.
Insights
Surgical liver biopsies are more effective than percutaneous ones for pediatric biliary atresia patients, improving hospital use and leading to better outcomes like the Kasai procedure. Vulnerable populations may receive suboptimal care.
Area of Science:
- Pediatric Hepatology
- Surgical Outcomes Research
- Biliary Atresia Management
Background:
- Biliary atresia is a severe neonatal liver disease requiring timely diagnosis and treatment.
- Liver biopsy is crucial for diagnosing biliary atresia, but optimal methods for pediatric patients remain debated.
- Understanding the sequelae of different liver biopsy techniques is essential for improving patient care.
Purpose of the Study:
- To conduct a nationwide retrospective analysis of liver biopsy methods in pediatric patients with biliary atresia.
- To compare the outcomes, hospital utilization, and progression to definitive treatment across various biopsy types.
- To identify potential disparities in care for vulnerable populations.
Main Methods:
- Utilized the National Inpatient Sample (NIS) database from 2001-2013.
- Identified pediatric patients with biliary atresia and stratified them by biopsy type: percutaneous, surgical, laparoscopic, and transjugular.
- Compared demographics, length of stay, hospital costs, treatments, and mortality using ANOVA and logistic regression.
Main Results:
- Analyzed 4,306 patients; 2,293 had no biopsy, 723 percutaneous, and 1,080 surgical.
- Significant differences in demographics, length of stay, and hospital charges were observed between biopsy groups.
- Surgical biopsies were associated with better hospital utilization and higher rates of Kasai procedure or liver transplantation compared to percutaneous biopsies.
Conclusions:
- Surgical liver biopsies demonstrate superior outcomes in hospital utilization and progression to definitive treatments (Kasai procedure) compared to percutaneous biopsies in pediatric biliary atresia.
- Vulnerable populations may experience disparities in treatment, receiving inferior care or less frequent definitive interventions.
- There is an unmet need for standardized diagnostic guidelines for liver biopsies in biliary atresia patients.
Abstract:
Objectives To present a nationwide retrospective analysis of the sequelae and aftereffects of different liver biopsy methods in the care of pediatric patients with biliary atresia. Methods The National Inpatient Sample 2001-2013 database was queried for a primary diagnosis of biliary atresia and stratified based on biopsy type including percutaneous, surgical, laparoscopic, and transjugular. Patient demographics, length of stay, hospital costs, type of treatment, and mortality were compared by biopsy type. One-way analysis of variance test and multivariable logistic regression were used for analysis with α < 0.05. Results A total of 4,306 patients with biliary atresia were identified, of whom 2,293 underwent no biopsy, and 723 and 1,080 underwent a percutaneous or surgical biopsy, respectively. Significant differences in socio-demographics were demonstrated between the biopsy types. The length of stay and hospital charges were statistically significantly different between the biopsy types where patients without biopsies had the smallest length compared to percutaneous, surgical, and combination of biopsies. Overall, the Kasai procedure was done more frequently compared to direct liver transplantation, and compared to other biopsy types, undergoing a combination of biopsies had the highest odds of undergoing either procedure. Conclusions When comparing different biopsy methods, surgical biopsies of the liver outperformed percutaneous biopsies in hospital utilization and progression to definitive treatments with the Kasai procedure. Our research indicated that vulnerable populations such as minorities or the indigent may undergo inferior treatments or infrequently undergo definitive treatment. The need for definitive diagnostic guidelines is understated in patients with biliary atresia.
