Variability in perioperative evaluation and resource utilization in pediatric patients with suspected biliary dyskinesia: A multi-institutional retrospective cohort study

Pediatric Surgery Research Collaborative (PedSRC)

Research output: Contribution to journalArticle

Abstract

Introduction: Biliary dyskinesia (BD)is a common indication for pediatric cholecystectomy. While diagnosis is primarily based on diminished gallbladder ejection fraction (GB-EF), work-up and management in pediatrics is controversial. Methods: We conducted a multi-institutional retrospective review of children undergoing cholecystectomy for BD to compare perioperative work-up and outcomes. Results: Six hundred seventy-eight patients across 16 institutions were included. There was no significant difference in gender, age, or BMI between institutions. Most patients were white (86.3%), non-Hispanic (79.9%), and had private insurance (55.2%). Gallbladder ejection fraction (EF)was reported in 84.5% of patients, and 44.8% had an EF < 15%. 30.7% of patients were initially seen by pediatric surgeons, 31.3% by pediatric gastroenterologists, and 23.4% by the emergency department with significant variability between institutions (p < 0.001). Symptoms persisted in 35.3% of patients post-operatively with a median follow-up of 21 days (IQR 13, 34). On multivariate analysis, only non-white race and the presence of psychiatric comorbidities were associated with increased risk of post-operative symptoms. Conclusion: There is significant variability in evaluation and follow-up both before and after cholecystectomy for BD. Prospective research with standardized data collection and follow-up is needed to develop and validate optimal care pathways for pediatric patients with suspected BD. Study type: Case Series, Retrospective Review. Level of evidence: Level IV.

Original languageEnglish (US)
Pages (from-to)1118-1122
Number of pages5
JournalJournal of pediatric surgery
Volume54
Issue number6
DOIs
StatePublished - Jun 1 2019

Fingerprint

Biliary Dyskinesia
Cohort Studies
Retrospective Studies
Pediatrics
Cholecystectomy
Gallbladder
Insurance
Psychiatry
Hospital Emergency Service
Comorbidity
Multivariate Analysis
Research

Keywords

  • Biliary dyskinesia
  • Cholecystectomy
  • Functional gallbladder disorder
  • Gastroenterology
  • Pediatric surgery

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Variability in perioperative evaluation and resource utilization in pediatric patients with suspected biliary dyskinesia : A multi-institutional retrospective cohort study. / Pediatric Surgery Research Collaborative (PedSRC).

In: Journal of pediatric surgery, Vol. 54, No. 6, 01.06.2019, p. 1118-1122.

Research output: Contribution to journalArticle

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title = "Variability in perioperative evaluation and resource utilization in pediatric patients with suspected biliary dyskinesia: A multi-institutional retrospective cohort study",
abstract = "Introduction: Biliary dyskinesia (BD)is a common indication for pediatric cholecystectomy. While diagnosis is primarily based on diminished gallbladder ejection fraction (GB-EF), work-up and management in pediatrics is controversial. Methods: We conducted a multi-institutional retrospective review of children undergoing cholecystectomy for BD to compare perioperative work-up and outcomes. Results: Six hundred seventy-eight patients across 16 institutions were included. There was no significant difference in gender, age, or BMI between institutions. Most patients were white (86.3{\%}), non-Hispanic (79.9{\%}), and had private insurance (55.2{\%}). Gallbladder ejection fraction (EF)was reported in 84.5{\%} of patients, and 44.8{\%} had an EF < 15{\%}. 30.7{\%} of patients were initially seen by pediatric surgeons, 31.3{\%} by pediatric gastroenterologists, and 23.4{\%} by the emergency department with significant variability between institutions (p < 0.001). Symptoms persisted in 35.3{\%} of patients post-operatively with a median follow-up of 21 days (IQR 13, 34). On multivariate analysis, only non-white race and the presence of psychiatric comorbidities were associated with increased risk of post-operative symptoms. Conclusion: There is significant variability in evaluation and follow-up both before and after cholecystectomy for BD. Prospective research with standardized data collection and follow-up is needed to develop and validate optimal care pathways for pediatric patients with suspected BD. Study type: Case Series, Retrospective Review. Level of evidence: Level IV.",
keywords = "Biliary dyskinesia, Cholecystectomy, Functional gallbladder disorder, Gastroenterology, Pediatric surgery",
author = "{Pediatric Surgery Research Collaborative (PedSRC)} and Cairo, {Sarah B.} and Arturo Aranda and Marisa Bartz-Kurycki and Baxter, {Katherine J.} and Patrick Bonasso and Melvin Dassinger and Deans, {Katherine J.} and Danielle Dorey and Pamela Emengo and Elizabeth Fialkowski and Christopher Gayer and Brandy Gonzales and Nakada Gusman and Hawkins, {Russell B.} and Karen Herzing and Eunice Huang and Saleem Islam and Timothy Jancelewicz and Landman, {Matthew P.} and Lally, {Kevin P.} and Aaron Lesher and Minneci, {Peter C.} and Raval, {Mehul V.} and Robert Russell and Sohail Shah and Bethany Slater and Schoel, {Leah J.} and Peter, {Shawn St} and Joseph Sujka and Jennifer Waterhouse and Rothstein, {David H.}",
year = "2019",
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T2 - A multi-institutional retrospective cohort study

AU - Pediatric Surgery Research Collaborative (PedSRC)

AU - Cairo, Sarah B.

AU - Aranda, Arturo

AU - Bartz-Kurycki, Marisa

AU - Baxter, Katherine J.

AU - Bonasso, Patrick

AU - Dassinger, Melvin

AU - Deans, Katherine J.

AU - Dorey, Danielle

AU - Emengo, Pamela

AU - Fialkowski, Elizabeth

AU - Gayer, Christopher

AU - Gonzales, Brandy

AU - Gusman, Nakada

AU - Hawkins, Russell B.

AU - Herzing, Karen

AU - Huang, Eunice

AU - Islam, Saleem

AU - Jancelewicz, Timothy

AU - Landman, Matthew P.

AU - Lally, Kevin P.

AU - Lesher, Aaron

AU - Minneci, Peter C.

AU - Raval, Mehul V.

AU - Russell, Robert

AU - Shah, Sohail

AU - Slater, Bethany

AU - Schoel, Leah J.

AU - Peter, Shawn St

AU - Sujka, Joseph

AU - Waterhouse, Jennifer

AU - Rothstein, David H.

PY - 2019/6/1

Y1 - 2019/6/1

N2 - Introduction: Biliary dyskinesia (BD)is a common indication for pediatric cholecystectomy. While diagnosis is primarily based on diminished gallbladder ejection fraction (GB-EF), work-up and management in pediatrics is controversial. Methods: We conducted a multi-institutional retrospective review of children undergoing cholecystectomy for BD to compare perioperative work-up and outcomes. Results: Six hundred seventy-eight patients across 16 institutions were included. There was no significant difference in gender, age, or BMI between institutions. Most patients were white (86.3%), non-Hispanic (79.9%), and had private insurance (55.2%). Gallbladder ejection fraction (EF)was reported in 84.5% of patients, and 44.8% had an EF < 15%. 30.7% of patients were initially seen by pediatric surgeons, 31.3% by pediatric gastroenterologists, and 23.4% by the emergency department with significant variability between institutions (p < 0.001). Symptoms persisted in 35.3% of patients post-operatively with a median follow-up of 21 days (IQR 13, 34). On multivariate analysis, only non-white race and the presence of psychiatric comorbidities were associated with increased risk of post-operative symptoms. Conclusion: There is significant variability in evaluation and follow-up both before and after cholecystectomy for BD. Prospective research with standardized data collection and follow-up is needed to develop and validate optimal care pathways for pediatric patients with suspected BD. Study type: Case Series, Retrospective Review. Level of evidence: Level IV.

AB - Introduction: Biliary dyskinesia (BD)is a common indication for pediatric cholecystectomy. While diagnosis is primarily based on diminished gallbladder ejection fraction (GB-EF), work-up and management in pediatrics is controversial. Methods: We conducted a multi-institutional retrospective review of children undergoing cholecystectomy for BD to compare perioperative work-up and outcomes. Results: Six hundred seventy-eight patients across 16 institutions were included. There was no significant difference in gender, age, or BMI between institutions. Most patients were white (86.3%), non-Hispanic (79.9%), and had private insurance (55.2%). Gallbladder ejection fraction (EF)was reported in 84.5% of patients, and 44.8% had an EF < 15%. 30.7% of patients were initially seen by pediatric surgeons, 31.3% by pediatric gastroenterologists, and 23.4% by the emergency department with significant variability between institutions (p < 0.001). Symptoms persisted in 35.3% of patients post-operatively with a median follow-up of 21 days (IQR 13, 34). On multivariate analysis, only non-white race and the presence of psychiatric comorbidities were associated with increased risk of post-operative symptoms. Conclusion: There is significant variability in evaluation and follow-up both before and after cholecystectomy for BD. Prospective research with standardized data collection and follow-up is needed to develop and validate optimal care pathways for pediatric patients with suspected BD. Study type: Case Series, Retrospective Review. Level of evidence: Level IV.

KW - Biliary dyskinesia

KW - Cholecystectomy

KW - Functional gallbladder disorder

KW - Gastroenterology

KW - Pediatric surgery

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