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J Pediatr Surg. 2019 Jun;54(6):1118-1122. doi: 10.1016/j.jpedsurg.2019.02.049. Epub 2019 Mar 2.

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

Author information

1
Department of Pediatric Surgery, John R Oishei Children's Hospital, Buffalo, NY. Electronic address: scairo2@gmail.com.
2
Department of Pediatric Surgery, Dayton Children's Hospital, Dayton, OH.
3
Department of Pediatric Surgery, McGovern Medical School at UT Health and Children's Memorial Hermann Hospital, Houston, TX.
4
Department of Pediatric Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA.
5
Department of Pediatric Surgery, Arkansas Children's Hospital, Springdale, AR.
6
Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH.
7
Department of Pediatric Surgery, Children's Hospital of Los Angeles, Los Angeles, CA.
8
Jacobs School of Medicine and Biomedical Science, University at Buffalo, Buffalo, NY.
9
Department of Pediatric Surgery, Oregon Health and Sciences University, Portland, OR.
10
Department of Pediatric Surgery, Baylor Pediatric Surgery, Houston, TX.
11
Department of Pediatric Surgery, University of Florida, Gainesville, FL.
12
Division of Pediatric Surgery, The University of Tennessee Health Sciences Center, Le Bonheur Children's Hospital, Memphis, TN.
13
Division of Pediatric Surgery, Indiana University, Indianapolis, IN.
14
Department of Pediatric Surgery, Medical University of South Carolina, Charleston, SC.
15
Department of Pediatric Surgery, University of Alabama at Birmingham, Birmingham, AL.
16
Department of Pediatric Surgery, University of Chicago, Chicago, IL.
17
Department of Pediatric Surgery, Children's Mercy Kansas City, Kansas City, KS.
18
Department of Pediatric Surgery, John R Oishei Children's Hospital, Buffalo, NY; Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY.

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

PMID:
30885555
PMCID:
PMC6822378
[Available on 2020-06-01]
DOI:
10.1016/j.jpedsurg.2019.02.049
[Indexed for MEDLINE]

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