title: Cholangitis in children with biliary atresia: health-care resource utilisation.
abstract: OBJECTIVE
  Cholangitis is a well-known complication that contributes to morbidity, mortality, as well as health-care utilisation in children with biliary atresia who have undergone the Kasai portoenterostomy. The aim of the study was to determine the common causative organisms for cholangitis and characterise its burden, health-care resource and service utilisation and cost.
  
  
  METHODS
  This was a retrospective chart review of children who underwent Kasai portoenterostomy in our institution from 1988 to 2011. The causative organisms were identified based on culture reports. The burden of the disease was estimated based on the number of patients experiencing one or more episodes of cholangitis. Health-care resource and service utilisation were based on different categories, and cost was computed based on the charges at the institution.
  
  
  RESULTS
  Twenty-seven (64.3%) out of 42 children included in the analysis experienced at least one episode of cholangitis. There were a total of 97 episodes of cholangitis, with an average of 3.6 (1-15) episodes per patient. The average length of stay per episode of cholangitis was 14.8 (2-64) days. Common organisms isolated during blood cultures were Klebsiella pneumoniae, Enterococcus, Escherichia coli and Pseudomonas aeruginosa. The estimated cost per in-patient admission of 15 days (rounded off) for a single episode of cholangitis was $SG 8986.61 ($US 7369.02).
  
  
  CONCLUSIONS
  The knowledge about the incidence and cost of cholangitis will allow physicians to counsel parents of children newly diagnosed with biliary atresia and to better prepare them both emotionally and financially for what to expect.
authors.affiliation: Yong Loo Lin, School of Medicine, , National University of Singapore, Singapore, Singapore.
authors.forename: Jie Ying
authors.initials: JY
authors.lastname: Lee
authors.forename: Leon Tak Keet
authors.initials: LT
authors.lastname: Lim
authors.forename: Seng Hock
authors.initials: SH
authors.lastname: Quak
authors.forename: Krishnan
authors.initials: K
authors.lastname: Prabhakaran
authors.forename: Marion
authors.initials: M
authors.lastname: Aw
mesh_terms: D001656:Biliary Atresia / Q000150:complications / Q000601:surgery*; D002761:Cholangitis / Q000191:economics* / Q000453:epidemiology / Q000209:etiology; D017281:Cost of Illness; D005260:Female; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D008485:Medical Audit; D011171:Portoenterostomy, Hepatic; D011183:Postoperative Complications; D012189:Retrospective Studies; D012846:Singapore
keywords: biliary atresia; cholangitis; paediatrics; resource utilisation.