Surgical outcomes in neonates and infants with congenital choledochal malformation: analysis of the Pediatric Health Information System (PHIS) database.
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BACKGROUND: Optimal timing for surgical correction of congenital choledochal malformations (CCMs) remains controversial. This study aims to evaluate whether younger age at surgery is an independent risk factor for higher morbidity. METHODS: The Pediatric Health Information System (PHIS) database (October 2015-September 2024) was queried to identify children aged ≤ 1 year undergoing definitive surgery for CCMs. Patient characteristics and outcomes of children aged ≤ 3 months (Group A) were compared with children > 3 months old (Group B). RESULTS: 267 patients (Group A:71, Group B:196) were identified. Younger children were more often transferred from other hospitals (p = 0.047), admitted urgently/emergently (p = 0.001), and underwent open bilioenteric reconstruction (p < 0.001). There were no differences in 90-day complications (Group A:19.7%, Group B:17.3%, p = 0.719) and postoperative procedures (18.3% vs. 14.3%; p = 0.444). Specifically, there were no differences in anastomotic revision (1.4% vs. 2%, p = 1.000) or endoscopic dilation (2.8% vs. 1.3%, p = 0.611). Within 90 days, younger children were more often readmitted (16.9% vs. 5.6%, p = 0.006). Six patients developed portal hypertension (Group A:7% and Group B:0.5%; p = 0.006), and one died from liver transplant complications. CONCLUSION: This study’s analysis of national surgical outcomes for CCMs supports the safety of early surgical intervention to prevent cyst-related complications and progression toward liver fibrosis.