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

• Type of Material: Article
• Authors: Sarah B. Cairo, John R Oishei Children’s Hospital, Buffalo, NY; Arturo Aranda, Dayton Children's Hospital; Marisa Bartz-Kurycki, University of Texas Houston; Katherine J. Baxter, Emory University; Patrick Bonasso, Arkansas Children's Hospital; Melvin Dassinger, Arkansas Children's Hospital; Katherine J. Deans, Nationwide Children's Hospital; Danielle Dorey, Children's Hospital Los Angeles; Pamela Emengo, University at Buffalo; Mehul Raval, Emory University
• Language: English
• Date: 2019-06-01
• Publisher: W. B. Saunders Co. & Elsevier Inc.
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 Elsevier Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jpedsurg.2019.02.049
• Title of Journal or Parent Work: Journal of Pediatric Surgery
• Volume: 54
• Issue: 6
• Start Page: 1118
• End Page: 1122
• Grant/Funding Information: None declared
• Keywords: Life Sciences & Biomedicine; Laparoscopic cholecystectomy; Functional gallbladder; Functional gallbladder disorder; Pediatric surgery; Gastroenterology; Children; Cholecystectomy; Surgery; Science & Technology; Pediatrics; Abdominal pain; Biliary dyskinesia
• Research Categories: Engineering, Biomedical; Health Sciences, Medicine and Surgery; Health Sciences, Human Development

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.