Referral Patterns, Co-occurring Conditions and Survival Outcomes of Biliary Atresia in Thailand: A Data Mining Study from the National Health Security Office Registry

Kulpreeya Sirichamratsakul; Surasak Sangkhathat; Virasakdi Chongsuvivatwong

doi:10.33192/smj.v77i5.272428

Authors

Kulpreeya Sirichamratsakul Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla 90110, Thailand
Surasak Sangkhathat Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla 90110, Thailand; Translational Medicine Research Center, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla 90110, Thailand
Virasakdi Chongsuvivatwong Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla 90110, Thailand

DOI:

https://doi.org/10.33192/smj.v77i5.272428

Keywords:

Biliary atresia, children, infants, survival, Thailand

Abstract

Objective: This study aimed to identify comorbidities and referral patterns in biliary atresia (BA) patients and analyze their influence on survival outcomes using a large national reimbursement cohort.

Materials and Methods: Data were extracted from the National Health Security Office (NHSO) registry via the Thai Health Information Portal (THIP). Patients under six years with a diagnosis of BA between 2017 and 2022 were included. Comorbidities, referral patterns, and survival were analyzed; association rule analysis was performed using the mlxtend package in Python 3.9, whereas survival analysis was conducted using the Kaplan Meier survival curve.

Results: In total, 957 BA cases among 4,168 admissions were included. The estimated annual incidence was 108.7 cases (1.8 per 10,000 live births). The 2- and 5-year survival rates were 75.1% and 72.5%, respectively. Association rules analysis revealed that metabolic disorders, liver cirrhosis, and portal hypertension had a high confidence of co-occurrence with BA. Anemia, coagulation disorders, malnutrition, liver cirrhosis, hepatic failure, ascites, and hypoalbuminemia were significantly associated with poorer survival outcomes. Cases with more than one referral before a definitive surgery significantly had poorer survival outcomes.

Conclusion: Overall, BA patients in Thailand had fair survival rates. Co-occurring progressive liver diseases, anemia, coagulation disorders, malnutrition, and prolonged referrals significantly contribute to poorer survival. Managing these peri-operative factors might improve the outcome of this devastating disease.

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