Outcome for biliary atresia patients treated at a low-volume centre

Björnland, Kristin; Hinna, Maren; Aksnes, Gunnar; Stensrud, Kjetil Juul; Ertresvåg, Kjetil; Bjørnstad-Østensen, Anniken; Sanengen, Truls; Line, Pål–Dag; Aagenæs, Ingegerd; Aabakken, Lars; Emblem, Ragnhild; Almaas, Runar

doi:10.1080/00365521.2018.1439097

Cited by 5 publications

(5 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It evaluates patient outcomes based on surgeon experience and has been applied to certain pediatric surgical conditions, such as tracheoesophageal fistula and biliary atresia. 18 19 Some surgical procedures are associated with better outcomes when performed at larger volume programs. 20 21 In their systematic review, McAteer et al also showed that surgeon-level factors such as case volume tend to correlate with outcomes for more common procedures, while hospital-level factors such as resources tend to correlate with outcomes for higher complexity procedures.…”

Section: Discussionmentioning

confidence: 99%

Variations in Nuss Procedure Operative Techniques and Complications: A Retrospective Review

et al. 2021

View full text Add to dashboard Cite

Introduction The Nuss procedure is the most common and preferred operative correction of pectus excavatum. Surgeon preference and patient factors can result in variations in Nuss procedure technique. We hypothesize that certain techniques are associated with increased risk of complications. Materials and Methods We performed a single-center retrospective review of Nuss operations from 2016 to 2020. Variations in intraoperative techniques included sternal elevator (SE) use, number of bars placed, and usage of bilateral stabilizing sutures. Patient demographics, intraoperative data, and postoperative outcomes were reported as median with interquartile ranges or percentages. Statistical significance (p < 0.05) was determined with Wilcoxon's rank-sum and chi-square tests. Multivariate analysis was performed to control for introduction of intercostal nerve cryoablation and surgeon volume, and reported as odds ratio with 95% confidence interval. Results Two hundred and sixty-five patients were identified. Patients repaired with two bars were older with a larger Haller index (HI). Patient demographics were not significantly different for SE or stabilizing suture use. Placement of two bars was associated with significantly increased risk of readmission. Similarly, SE use was associated with increased risk of pleural effusion and readmission. Finally, the use of bilateral stabilizing sutures resulted in less frequent slipped bars without statistical significance. Conclusion Older patients with a larger HI were more likely to need two bars placed to repair pectus excavatum. Placement of multiple bars and SE use are associated with significantly higher odds of certain complications.

show abstract

Section: Discussionmentioning

confidence: 99%

Variations in Nuss Procedure Operative Techniques and Complications: A Retrospective Review

et al. 2021

View full text Add to dashboard Cite

show abstract

“…The adequate level of transection of the fibrous portal plate is one of the most important steps in the Kasai procedure, which is also the most difficult part of the operation. The native liver survival (NLS) rate is clearly different in different centers [4~7] .At present, most studies showed that early clearance of jaundice after Kasai procedure is an important factor for good prognosis [4,5] . The adequate level of transection of the fibrous portal plate plays a key role in the early clearance of jaundice [1] .…”

Section: Discussionmentioning

confidence: 99%

Liver stiffness measurement predicts the difficulty of Kasai procedure in Biliary Atresia: a single center retrospective analysis of 199 patients

Shen

Chen

Peng

et al. 2019

Preprint

View full text Add to dashboard Cite

Background: Kasai procedure is the standard initial treatment of infants with biliary atresia. The key to perform a successful surgery is to accurately remove the fibrous portal plate near the liver hilum. Yet how to estimate surgical difficulty pre-operatively remains unclear. This study aims to design an algorithm that predicts the difficulty of Kasai procedure using liver stiffness measurement (LSM). Methods: 199 patients were included from April 2012 to December 2016. The patients were all surgically diagnosed with biliary atresia. Group A comprised of patients with porta hepatis retraction (the angle between the plane of the fibrous porta plate and the plane of the medial liver closest to the plate was equal to or smaller than 90°), group B comprised of patients without porta hepatis retraction (the angle between the plane of the fibrous porta plate and the plane of the medial liver closest to the plate was greater than 90°). Liver function measurements and LSM were measured for all patients within three days before surgery. Results: Our study included 19 cases in group A (9 males, 10 females) and 180 cases in group B (87 males, 93 females). LSM had statistical differences between the two groups, 28.10(14.90) kPa VS 10.89(7.10) kPa, P =0.000. There was a significant relationship between LSM and operative age, TBA, AST, GGT (P=0.000, 0.003, 0.003, 0.012, correlation coefficient =0.323, 0.213, 0.207, 0.179). The AUROC of LSM was 0.919. When the cutoff value was 15.15 kPa(OR=3.989; P = 0.000), the sensitivity, specificity, PPV, NPV and diagnostic accuracy were 0.947, 0.750, 0.285, 0.992 and 0.768, respectively. When the value was 23.75kPa(OR=3.483; P = 0.000), the sensitivity, specificity, PPV, NPV and diagnostic accuracy were 0.631, 0.950, 0.571, 0.960 and 0.919, respectively. Conclusions: LSM can be used to predict the difficulty in dissecting fibrous portal plate, and in turn, the difficulty of Kasai procedure. LSM>23.75 kPa suggests a more complicated surgery.

show abstract

“…The adequate level of transection of the fibrous portal plate is one of the most important steps in the Kasai procedure, which is also the most difficult part of the operation. The native liver survival (NLS) rate is clearly different in different centers [4–7]. At present, most studies showed that early clearance of jaundice after Kasai procedure is an important factor for good prognosis [4, 7].…”

Section: Discussionmentioning

confidence: 99%

“…The native liver survival (NLS) rate is clearly different in different centers [4–7]. At present, most studies showed that early clearance of jaundice after Kasai procedure is an important factor for good prognosis [4, 7]. The adequate level of transection of the fibrous portal plate plays a key role in the early clearance of jaundice [1].…”

Section: Discussionmentioning

confidence: 99%

Liver stiffness measurement predicts the difficulty of Kasai procedure in biliary atresia: a single center retrospective analysis of 199 patients

et al. 2019

View full text Add to dashboard Cite

BackgroundKasai procedure is the standard initial treatment of infants with biliary atresia. The key to perform a successful surgery is to accurately remove the fibrous portal plate near the liver hilum. Yet how to estimate surgical difficulty pre-operatively remains unclear. This study aims to design an algorithm that predicts the difficulty of Kasai procedure using liver stiffness measurement (LSM).MethodsOne hundred ninety-nine patients were included from April 2012 to December 2016. The patients were all surgically diagnosed with biliary atresia. Group A comprised of patients with porta hepatis retraction (the angle between the plane of the fibrous porta plate and the plane of the medial liver closest to the plate was equal to or smaller than 90°), group B comprised of patients without porta hepatis retraction (the angle between the plane of the fibrous porta plate and the plane of the medial liver closest to the plate was greater than 90°). Liver function measurements and LSM were measured for all patients within three days before surgery.ResultsOur study included 19 cases in group A (9 males, 10 females) and 180 cases in group B (87 males, 93 females). LSM had statistical differences between the two groups, 28.10(14.90) kPa VS 10.89(7.10) kPa, P = 0.000. There was a significant relationship between LSM and operative age, TBA, AST, GGT (P = 0.000, 0.003, 0.003, 0.012, correlation coefficient = 0.323, 0.213, 0.207, 0.179). The AUROC of LSM was 0.919. When the cutoff value was 15.15 kPa(OR = 3.989; P = 0.000), the sensitivity, specificity, PPV, NPV and diagnostic accuracy were 0.947, 0.750, 0.285, 0.992 and 0.768, respectively. When the value was 23.75 kPa(OR = 3.483; P = 0.000), the sensitivity, specificity, PPV, NPV and diagnostic accuracy were 0.631, 0.950, 0.571, 0.960 and 0.919, respectively.ConclusionsLSM can be used to predict the difficulty in dissecting fibrous portal plate, and in turn, the difficulty of Kasai procedure. LSM > 23.75 kPa suggests a more complicated surgery.

show abstract

Outcome for biliary atresia patients treated at a low-volume centre

Abstract: A small volume centre may achieve satisfactory results for BA patients. The study has, however, identified factors that may further improve results; earlier referral, optimizing diagnostic work-up and establishing one dedicated surgical team.

Cited by 5 publications

References 20 publications

Variations in Nuss Procedure Operative Techniques and Complications: A Retrospective Review

Variations in Nuss Procedure Operative Techniques and Complications: A Retrospective Review

Liver stiffness measurement predicts the difficulty of Kasai procedure in Biliary Atresia: a single center retrospective analysis of 199 patients

Liver stiffness measurement predicts the difficulty of Kasai procedure in biliary atresia: a single center retrospective analysis of 199 patients

Contact Info

Product

Resources

About