Variability in age at Kasai portoenterostomy for biliary atresia across US children's hospitals

Abstract

Background/PurposeThe purpose of this study was to assess variability in age at Kasai portoenterostomy (KP) in infants with biliary atresia (BA) across children's hospitals in the United States. Study DesignA multi-institutional retrospective study was performed examining infants with BA undergoing KP within 6 months of birth from 2016–2019, utilizing the Pediatric Health Information System (PHIS). Multivariable negative binomial mixed effects regression was performed for age at KP, and inter-hospital variability was examined. ResultsAcross 46 hospitals, 470 infants with BA underwent KP at a median age of 57 days (IQR 42–72), with 212 (45.1%) undergoing KP at ≥60 days of age. There was significant inter-hospital variability in age at KP ranging from 38 days (95% CI: 31d, 47d) to 76 days (95% CI: 63d, 91d) (p<0.0001). Factors associated with later KP were black or African-American race, urgent/emergent admission, and treatment at a hospital in the Pacific-West region. Predictors of earlier KP included later year, history of neonatal comorbidity, and admission to an intensive care service (all p<0.05). ConclusionThere is significant variability in the age at KP in infants with BA across children's hospitals in the United States. Type of StudyRetrospective study. Level of Evidence. III