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Kasai hepatoportoenterostomy in S outh A ustralia: a case for ‘centralized decentralization’
Author(s) -
Tu Chen Gang,
Khurana Sanjeev,
Couper Richard,
Ford Andrew W. D.
Publication year - 2015
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.12522
Subject(s) - medicine , biliary atresia , jaundice , child survival , survival analysis , liver transplantation , survival rate , overall survival , decentralization , population , incidence (geometry) , demography , surgery , transplantation , health services , environmental health , physics , optics , sociology , political science , law
Background Recent follow‐up studies have demonstrated significant improvement in overall survival as well as survival with native liver following geographic centralization of services to three centres in the UK . However, this model has not been replicated in countries with relatively low population density such as A ustralia and C anada. Methods Retrospective evaluation of all patients born with biliary atresia ( BA ) in S outh A ustralia from 1989 to 2010 was performed. Thirty‐one patients with BA were discovered. Two patients were excluded because the initial Kasai procedure ( KP ) was performed interstate. Outcome parameters measured were (i) clearance of jaundice (bilirubin of less than 20 μmol/L, by 6 months); (ii) survival with native liver; and (iii) overall survival. K aplan– M eier survival curves were plotted for both survival with native liver and overall survival. Results The incidence of BA in S outh A ustralia between 1989 and 2010 was 7.48 per 100 000 live births. Following KP , clearance of jaundice was achieved in 42.9% of patients. Five‐year actuarial survival with native liver was 55.2%, and overall 5‐year actuarial survival was 89.3%. Conclusions The results of KP performed at Women's and Children's Hospital from 1989 to 2010 can be considered comparable with international benchmarks. Based on these results, we propose the creation of a ‘centralized’ pool of surgeons in A ustralia to help continue providing ‘decentralized’ care of BA .