ABSTRACT
INTRODUCTION: Biliary atresia implies high risk of mortality if not diagnosed and treated early. We undertook this study to assess the prognostic factors affecting the outcome of Kasai surgery. METHODS: A retrospective clinical study was conducted among 58 patients from Hospital Sultanah Bahiyah Alor Setar. Data were analysed with logistic regression analysis using SPSS. Factors studied included age during surgery, bile duct diameter at the porta hepatic, race of patient, preoperative total bilirubin level and cholangitis. These factors were analysed to determine its significance as a prognostic factor affecting the outcome of Kasai surgery. RESULTS: Older age group above 56 days of life, bile duct diameter at porta hepatis measuring <50µm, pre-operative total bilirubin >10mg% and cholangitis were found to be poor prognostic factors from univariate regression analysis. Variables having p value<0.025 were analysed using the multivariable regression analysis. Only age of patient and diameter of bile duct at the porta hepatis were eligible for this analysis. The final analysis showed that age 57 days of life and above (adjusted odd's ratio (aOR) = 9.412, p value = 0.042, 95% confidence interval (95%CI) = 1.079 to 82.104) and bile duct diameter <50µm (aOR = 13.812, p value = 0.016, 95%CI = 1.616 to 118.042) were significant factors affecting the outcome. CONCLUSION: In conclusion, age of patient 56 days of life and younger and diameter of bile duct at porta hepatis ≥50µm gave a significantly better outcome after Kasai surgery.
Subject(s)
Bile Ducts, Extrahepatic/surgery , Biliary Atresia/physiopathology , Portoenterostomy, Hepatic , Humans , Logistic Models , Malaysia , Outcome Assessment, Health Care , Retrospective StudiesABSTRACT
Oesophageal atresia (EA) and tracheoesophageal fistula (TEF) is one of the congenital anomaly occurring in the newborns with the incidence of 1 in 2500 births seen worldwide. A retrospective review of newborns admitted to Hospital Sultanah Bahiyah (HSB) from 1st January 2000 to 31st December 2009 was done. The objective was to look at the influence of birth weight, time of surgical intervention, presence of other congenital anomaly and presence of preoperative pneumonia to the immediate outcome (mortality) of the surgery. There were 47 patients with oesophageal atresia, out of which 26 (55%) were males and 21 (45%) females. The distribution of patients by race were 34 Malays (72%), 9 Chinese (19%) and 4 Indians (9%). The birth weight of the babies range from 0.8 kg to 4.0 kg and there was a significant association with the outcome of the surgery (p< 0.05). Most of the babies (20) were operated within 24 hours of presentation but there was no significant association to the outcome. 23 (49%) of them were born with congenital malformation and there was a significant association with the outcome of the surgery (p<0.05). Based on the chest roentgenogram, 20 (43%) of them had pneumonia with significant association with the outcome (p<0.05). The mortality rate is 23% and the causes of death were pneumonia (36%), renal failure (18%), cardiac malformation (18%) and multiple congenital malformations (28%). The outcome of EA and TEF is determined mainly by birth weight, congenital malformations and presence of preoperative pneumonia in HSB.
