Letter to the editor - Congenital cardiac disease and biliary atresia - Not a benign relationship

Connor et al. review the National Surgical Quality Improvement Progam-Pediatric (NSQIP-P) database (2012–22) identifying 854 infants from around the USA undergoing a Kasai portoenterostomy (KPE) with the aim of exploring the effect of any associated congenital heart disease (CHD) [1]. They identified 89(10 %). Compared to non-CHD these infants had a two-fold increase in complications if the CHD was “simple” and a three-fold increase if “complex” and importantly no deaths. The problem is that the data-stream stops conclusively at 30 days and all the real action tends to happen after that.