Same-Day versus Overnight Observation after Outpatient Pediatric Percutaneous Liver Biopsy: A Retrospective Cohort Study

Abstract

Purpose Percutaneous liver biopsy (PLB), a diagnostic procedure to identify several hepatobiliary disorders, is considered safe with low incidence of associated complications. While postoperative monitoring guidelines are suggested for adults, selection of procedural recovery time for children remains at the discretion of individual operators. We aim to determine if differences exist in frequency of surgical complications, unplanned admissions, and healthcare cost for children undergoing outpatient PLB for cohorts with same-day vs. overnight observation. Methods We performed a retrospective cohort study in children 1 month to 17 years of age undergoing ultrasound-guided PLB from January 2009 to August 2017 at a tertiary care, pediatric referral center. Cohorts were defined by postprocedural observation duration: same-day (≤8 hours) vs. overnight observation. Outcomes included surgical complications, medical interventions, unscheduled hospitalization within 7 days, and total encounter costs. Results One hundred and twelve children met study criteria of which 18 (16.1%) were assigned to same-day observation. No differences were noted in demographics, anthropometrics, comorbidities, biopsy indications, or preoperative coagulation profiles. No major complications or acute hospitalizations after PLB were observed. Administration of analgesia and fluid boluses were isolated and given within 8 hours. Compared to overnight monitoring, same-day observation accrued less total costs (US $992 less per encounter). Conclusion Same-day observation after PLB in children appears well-tolerated with only minor interventions and complications observed within 8 hours of procedure. We recommend a targeted risk assessment prior to selection of observation duration. Same-day observation appears an appropriate recovery strategy in otherwise low-risk children undergoing outpatient PLB.

Two‐hour Observation After Liver Biopsy in Children

“…The cost reduction would have been larger had the PACU indirect expenses included in the calculation. Kozlovich et al (17) concluded that embracing a shorter observation period following PLB as standard practice for children without major comorbidities can potentially lead to substantial positive economic impact. Similar observation was reported with a 1-hour observation that resulted in reduced facility fee cost, mainly related to decrease in nursing staff utilization with potential for significant cost savings and more efficient use of facility, space, and nursing staff (13).…”

Major complications after percutaneous biopsy of native or transplanted liver in pediatric patients: a nationwide inpatient database study in Japan

“…Previous studies have shown that major complications after PLB occur in 0-4.6% of pediatric patients [1,2,6,[8][9][10], and that younger age and hepatoblastoma or hepatocellular carcinoma were associated with complications following PLB in pediatric patients [6,7]. However, these studies did not consider whether PLB had been performed on native or transplanted liver.…”