Pediatr Gastroenterol Hepatol Nutr.  2019 Jul;22(4):377-386. 10.5223/pghn.2019.22.4.377.

Same-Day versus Overnight Observation after Outpatient Pediatric Percutaneous Liver Biopsy: A Retrospective Cohort Study

• Kozlovich
• Sochet AA
• Son S
• Wilsey MJ

• KMID: 2451578
• DOI: http://doi.org/10.5223/pghn.2019.22.4.377

Abstract

PURPOSE
Percutaneous liver biopsy (PLB), a diagnostic procedure to identify several hepatobiliary disorders, is considered safe with low incidence of associated complications. While postoperative monitoring guidelines are suggested for adults, selection of procedural recovery time for children remains at the discretion of individual operators. We aim to determine if differences exist in frequency of surgical complications, unplanned admissions, and healthcare cost for children undergoing outpatient PLB for cohorts with same-day vs. overnight observation.
METHODS
We performed a retrospective cohort study in children 1 month to 17 years of age undergoing ultrasound-guided PLB from January 2009 to August 2017 at a tertiary care, pediatric referral center. Cohorts were defined by postprocedural observation duration: same-day (≤8 hours) vs. overnight observation. Outcomes included surgical complications, medical interventions, unscheduled hospitalization within 7 days, and total encounter costs.
RESULTS
One hundred and twelve children met study criteria of which 18 (16.1%) were assigned to same-day observation. No differences were noted in demographics, anthropometrics, comorbidities, biopsy indications, or preoperative coagulation profiles. No major complications or acute hospitalizations after PLB were observed. Administration of analgesia and fluid boluses were isolated and given within 8 hours. Compared to overnight monitoring, same-day observation accrued less total costs (US $992 less per encounter).
CONCLUSION
Same-day observation after PLB in children appears well-tolerated with only minor interventions and complications observed within 8 hours of procedure. We recommend a targeted risk assessment prior to selection of observation duration. Same-day observation appears an appropriate recovery strategy in otherwise low-risk children undergoing outpatient PLB.

Keyword

Liver; Biopsy; Complications; Safety; Cost effectiveness; Observation

MeSH Terms

Adult
Analgesia
Biopsy*
Child
Cohort Studies*
Comorbidity
Cost-Benefit Analysis
Demography
Health Care Costs
Hospitalization
Humans
Incidence
Liver*
Outpatients*
Referral and Consultation
Retrospective Studies*
Risk Assessment
Tertiary Healthcare

Figure

• 

  Fig. 1 Box and whisker plot of total encounter costs following percutaneous liver biopsy for children with same-day vs. overnight observation.

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