Outcomes of Kasai Portoenterostomy in Patients with Congenital Heart Disease: A Silent Comorbidity.

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Tác giả: Charles D Fraser, Maria E Hoyos, Hugo R Martinez, Mario O'Connor, Andrew Well

Ngôn ngữ: eng

Ký hiệu phân loại:

Thông tin xuất bản: United States : Journal of pediatric surgery , 2025

Mô tả vật lý:

Bộ sưu tập: NCBI

ID: 727114

 INTRODUCTION: Biliary atresia(BA) is the most common cause of end-stage liver disease in children. Around 5%-15% of patients with BA have a congenital heart disease(CHD) diagnosis. Despite high prevalence of a CHD diagnosis in patients with BA, outcomes of Kasai portoenterostomy(KPE) in the CHD population remain unexplored METHODS: This is a retrospective review of the American College of Surgeons National Surgical Quality Improvement Program-Pediatric(NSQIP-P) database from 2012-2022. All patients undergoing KPE were included. Patients with CHD were identified using previously validated ICD9/10 codes. RESULTS: A total of 854 patients underwent a KPE during the study period. Of this cohort, 502(59%) were female, 342(40%) White Non-Hispanic, median age of 57.0[IQR:40.0-72.0] days, and a median weight of 9.4[IQR:8.1-10.7] kilograms. A total of 89(10%) patients had a diagnosis of CHD. Of those, 63(7%) had a simple-CHD diagnosis and 26(3%) a complex-CHD diagnosis. A single-ventricle(SV-CHD) diagnosis was present in 7(1%) patients. Notably, no in-hospital mortalities were found. When compared to non-CHD, simple-CHD(OR:2.51
 95%CI:1.45-4.36,p=0.001) and complex-CHD(OR:3.20
 95%CI:1.30-7.87,p=0.011) had increased risk for any complication. Furthermore, when compared to non-CHD complex-CHD patients had higher odds of undergoing a Kasai related reintervention(OR:5.01
 95%CI:1.76-14.22,p=0.002. After propensity score matching, when compared to non-CHD a CHD diagnosis was only associated with an increased risk for any complication(OR:2.50
 95%CI:1.30-4.81,p=0.005). CONCLUSION: A CHD diagnosis is present in 10% of children undergoing KPE. KPE appears to be safe in patients with CHD, but associated with increased in-hospital resource utilization. Further studies are needed to understand the impact of a CHD diagnosis on the long-term outcomes after KPE. TYPE OF STUDY: Retrospective Review LEVEL OF EVIDENCE: Level 3.
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