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

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.