PREDICTORS OF SURGICAL MORBIDITY IN PEDIATRIC HEPATIC HYDATID DISEASE: A RETROSPECTIVE STUDY FROM THE JORDANIAN ROYAL MEDICAL SERVICES

Abstract

Background: Pediatric hepatic hydatid disease is a major health problem in various regions. The concurrent pulmonary involvement in children is considered common and increase the postoperative risk. In our study assessed if pulmonary co-involvement independently predicts surgical morbidity. Methods: We conducted a retrospective study that analyzed 78 patients who underwent surgery for hepatic hydatid disease at a tertiary center. Patients were separated to two groups, only hepatic involvement (n = 33) and concurrent pulmonary involvement (n = 45). The primary outcome was clinically significant postoperative morbidity, defined as Clavien-Dindo grade II or higher. Firth's penalized logistic regression was used to identify independent predictors with internal validation by 1,000-bootstrap resampling. Results: We observed significant postoperative complications in 65.4% of patients, with a higher rate seen in the pulmonary group. (97.8% vs 21.2%, p < 0.001). We used the pulmonary involvement as the only independent predictor of morbidity (adjusted OR 156.82, 95% CI 25.96-2129.63, p < 0.001). In comparison between isolated hepatic disease and the pulmonary involvement patients we observed that the latter one had higher rates of intraoperative cyst rupture, secondary infection, and longer hospital stay (53.3% vs 18.2%, p = 0.002), (46.7% vs 12.1%, p = 0.001), (median 7 vs 4 days, p < 0.001) respectively. Conclusion: The study shows us that concurrent pulmonary involvement is a major independent predictor of postoperative morbidity in pediatric hepatic hydatid disease. Chest images and multidisciplinary perioperative planning should be considered in management of Pediatric hepatic hydatid disease.