Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
J Pediatr. 2018 Aug;199:237-242.e2. doi: 10.1016/j.jpeds.2018.04.001. Epub 2018 May 14.
To assess factors associated with timing of hepatoportoenterostomy (HPE) and adverse perioperative outcomes in patients with biliary atresia in the US.
We examined hospitalizations in infants aged <1 year using the National Inpatient Sample database for 2000-2011. We identified cases using the International Classification of Diseases, Ninth Revision, Clinical Modification codes for biliary atresia and HPE. Multivariable logistic regression models were used to examine association between select factors and age at HPE, as well as adverse perioperative outcomes.
Our analysis of 1243 biliary atresia hospitalizations showed that only 37.7% of patients had HPE in the first 60 days of life. Patients who underwent HPE after 60 days of age were uninsured, were more likely to be black (aOR, 4.22; 95% CI, 1.49-11.95), less likely to be admitted at a teaching hospital (aOR, 0.27; 95% CI 0.10-0.79), and less likely to have a concomitant congenital malformation (aOR, 0.49; 95% CI 0.25-0.98). Patients with delayed age at HPE incurred significantly higher hospital costs ($57 914 vs $34 074; P = .026). Delayed age at HPE and weekend admission were independently associated with increased odds of adverse perioperative outcome (aOR, 1.09; 95% CI, 1.01-3.02 and 3.98; 95% CI, 1.67-9.46, respectively).
Current outcomes in patients with biliary atresia in the United States are suboptimal and result in higher costs. The specific factors associated with delayed care are further evidence that universal health care and screening are needed for all infants, along with systematic referral of potential patients with biliary atresia to specialized health centers.
评估美国胆道闭锁患者行肝肠吻合术（HPE）的时机及围手术期不良结局的相关因素。
我们利用国家住院患者样本数据库，对 2000 年至 2011 年间年龄＜1 岁的婴儿住院情况进行了研究。我们使用国际疾病分类第 9 版临床修订版（ICD-9-CM）代码来识别胆道闭锁和 HPE 病例。多变量逻辑回归模型用于研究选定因素与 HPE 年龄以及围手术期不良结局之间的关联。
我们对 1243 例胆道闭锁住院患者的分析显示，只有 37.7%的患者在生命的前 60 天内接受了 HPE。60 天后接受 HPE 的患者未投保，更有可能是黑人（OR，4.22；95%CI，1.49-11.95），不太可能在教学医院就诊（OR，0.27；95%CI，0.10-0.79），且不太可能同时伴有先天性畸形（OR，0.49；95%CI，0.25-0.98）。HPE 年龄延迟的患者的住院费用显著更高（57914 美元 vs 34074 美元；P＝.026）。HPE 年龄延迟和周末入院与围手术期不良结局的发生几率增加独立相关（OR，1.09；95%CI，1.01-3.02 和 3.98；95%CI，1.67-9.46）。
目前美国胆道闭锁患者的治疗结果并不理想，导致医疗费用增加。与护理延迟相关的具体因素进一步证明，所有婴儿都需要全民医疗保险和筛查，并对可能患有胆道闭锁的患者进行系统转诊，以使其进入专门的医疗中心。
