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.
Keywords: Biopsy; Complications; Cost effectiveness; Liver; Observation; Safety.
Conflict of interest statement
Conflict of Interest: The authors have no financial conflicts of interest.
Use of the Pediatric Intensive Care Unit for Post-Procedural Monitoring in Young Children Following Microlaryngobronchoscopy: Impact on Resource Utilization and Hospital CostEJ Kerris et al. Int J Pediatr Otorhinolaryngol 115, 1-5. PMID 30368366.In children ≤ 2 years of age prophylactically admitted for PICU observation, we did not observe severe complications or major interventions after MLB. Minor interventions …
Endovascular Laser Therapy for Varicose Veins: An Evidence-Based AnalysisMedical Advisory Secretariat. Ont Health Technol Assess Ser 10 (6), 1-92. PMID 23074409.The MAS evidence search identified 14 systematic reviews, 29 cohort studies on safety and effectiveness, four cost studies and 12 randomized controlled trials involving E …
Limited Post-observation Period in Pediatric Outpatient Ultrasound-Guided Liver BiopsiesS Hayatghaibi et al. Cardiovasc Intervent Radiol 40 (12), 1899-1903. PMID 28597063.In a consecutive cohort of children, the use of a limited 2 h observation period after an ultrasound-guided percutaneous biopsy was a sufficient monitoring period for com …
Sutureless Aortic Valve Replacement for Treatment of Severe Aortic Stenosis: A Single Technology Assessment of Perceval Sutureless Aortic Valve [Internet]AS Desser et al. PMID 29553663. - ReviewBased on the cost-effectiveness and budget impact analyses performed by the firm Perceval can be cost-saving compared to traditional sutured valves for isolated full ster …
Pretherapeutic Evaluation of Patients With Upper Gastrointestinal Tract Cancer Using Endoscopic and Laparoscopic UltrasonographyMB Mortensen. Dan Med J 59 (12), B4568. PMID 23290296. - ReviewWith the results from the present thesis the author has defined and tested a new evaluation strategy based on the combination of EUS and LUS. This combination was supplem …
- Bilreiro C, Noruegas MJ, Gonçalves I, Moreira Â. Ultrasound-guided liver biopsies in children: a single-center experience and risk factors for minor bleeding. J Pediatr Gastroenterol Nutr. 2017;65:137–140. - PubMed
- Copel L, Sosna J, Kruskal JB, Kane RA. Ultrasound-guided percutaneous liver biopsy: indications, risks, and technique. Surg Technol Int. 2003;11:154–160. - PubMed
- Bolia R, Matta J, Malik R, Hardikar W. Outpatient liver biopsy in children: safety, feasibility, and economic impact. J Pediatr Gastroenterol Nutr. 2017;65:86–88. - PubMed
- Gonzalez-Vallina R, Alonso EM, Rand E, Black DD, Whitington PF. Outpatient percutaneous liver biopsy in children. J Pediatr Gastroenterol Nutr. 1993;17:370–375. - PubMed
- Weigand K, Weigand K. Percutaneous liver biopsy: retrospective study over 15 years comparing 287 inpatients with 428 outpatients. J Gastroenterol Hepatol. 2009;24:792–799. - PubMed