Mater Med Pol. 1998 Jan-Jun;30(1-2):6-11.

Factors affecting surgical mortality and morbidity in patients

with obstructive jaundice.
Gnll NN, Cantrk NZ, Utkan NZ, Yidirir C, Dlger M.

Source
Medical School, Kocaeli University, Turkey.

Abstract
The importance of clinical and laboratory parameters which have an effect on postoperative
mortality and morbidity was evaluated in 124 patients operated on because of obstructive
jaundice. The causes of obstructive jaundice were a malign disease in 38 patients (30.6%) and
a benign disease in 86 patients (69.4%). Biliary enteric anastomosis in 66 patients (53%),
external drainage in 46 patients (37%), and cholecystectomy in 12 patients (10%) were the
surgical techniques of choice for correction of obstructive jaundice. There were significantly
high mortality rates in patients with weight loss, more than 10 kg during preoperative the
month (p < 0.05); jaundice longer than 21 days, (p < 0.001); and malignancy caused jaundice
(p < 0.002). Haematocrite less than 30% (p < 0.05), albumin level below 3 g/dl (p < 0.01),
blood urea nitrogen level above 30 mg/dl (p < 0.001), and bilirubine above 10 mg/dl (p <
0.01) were determined as risk factors in mortality. Direct relationships between the number of
risk factors, complications, and mortality ratios were determined. One or more complications
were determined in patients with more than six risk factors. High mortality rate was also
determined in patients who had five and more risk factors. The following factors were
evaluated: respiratory, circulatory, renal functions, and infection, and metabolic concomitant
diseases, and comorbid scores for each patient were calculated. High rate complications in
patients with eight and more comorbid scores and high mortality rates in patients with six and
more were also determined. Finally, all these parameters were important in demonstrating
postoperative mortality in obstructive jaundice patients. We suggest that surgery after
treatment of correctable risk factors decreases postoperative morbidity and mortality.
PMID:
10214468
[PubMed - indexed for MEDLINE]

Int J Pancreatol. 1999 Feb;25(1):3-9.

Perioperative hepatic functional risk assessed with technetium-99m

diethylenetriamine pentaacetic acid-galactosyl human serum albumin
liver scintigraphy in patients undergoing pancreaticoduodenectomy
complicated by obstructive jaundice.
Nakano H, Kumada K, Takekuma Y, Hasebe S, Yoshizawa Y, Yamaguchi M, Jaeck D.

Source
Department of Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan.
Hiroshi.Nakano@chru-strasbourg.fr
Abstract
CONCLUSION:
Liver scintigraphy with technetium-99m diethylenetriamine pentaacetic acid-galactosyl human serum
albumin (Tc-GSA) can be used to predict outcome of biliary drainage and hepatic function after
pancreaticoduodenectomy in patients with pancreatic, biliary, and ampullary carcinomas complicated
by obstructive jaundice.
BACKGROUND:
Preoperative obstructive jaundice has been reported as a crucial risk factor for serious postoperative
complications in patients undergoing pancreaticoduodenectomy. The aim of the present study was to
investigate whether Tc-GSA liver scintigraphy can assess hepatic functional risk in patients with
pancreatic, biliary, and ampullary carcinomas complicated by obstructive jaundice.
METHODS:
Liver scintigraphy was performed before biliary drainage in 18 patients with obstructive jaundice. The
maximum removal rate of Tc-GSA (GSA-Rmax; standard normal value > or = 0.60) was calculated.
These patients underwent pancreaticoduodenectomy with wide lymphadenectomy. The efficacy of
preoperative biliary drainage was assessed with the decrease in serum bilirubin concentration in the
first week after biliary drainage. Postoperative liver function was assessed with the increase in serum
bilirubin concentration, which was the difference between the immediate preoperative and maximal
postoperative bilirubin concentrations.
RESULTS:
Serum bilirubin decreased more in the first week after biliary drainage in patients with GSA-Rmax >
or = 0.60 (7.64 +/- 1.09 mg/Dl/wk) than in patients with GSA-Rmax < 0.60 (3.56 +/- 1.25 mg/DL/wk,
p = 0.042). Postoperative bilirubin increased less in patients with GSA-Rmax > or = 0.60 (0.81 +/0.30 mg/dL) than in patients with GSA-Rmax < 0.60 (4.00 +/- 0.69 mg/DL, p = 0.0012). Multivariate
analysis showed that GSA-Rmax significantly predicted the postoperative bilirubin increase (p =
0.020).
PMID:
10211415
[PubMed - indexed for MEDLINE]

J Int Med Res. 2004 Nov-Dec;32(6):633-8.

Predictive value of risk factors in patients

with obstructive jaundice.
Pitiakoudis M, Mimidis K, Tsaroucha AK, Papadopoulos V, Karayiannakis A, Simopoulos C.

Source
Second Department of Surgery, Medical School, Democritus University of Thrace,
Alexandroupolis, Greece.

Abstract
Clinical and laboratory parameters that may affect post-operative mortality and morbidity
were studied in 215 patients operated on for obstructive jaundice. The cause of the bile duct
obstruction was benign disease in 56.7% of patients and malignant disease in 43.3%. Overall
postoperative mortality and morbidity rates were 21.9% and 33.5%, respectively. Eight risk
factors were shown to be associated with increased mortality: age > 70 years; malignancy;
leucocytosis > 15 000 cells/microl and fever > 38.5 degrees C; haematocrit < or = 30%;
creatinine > 1.3 mg/dl; albumin < or = 3 g/dl; bilirubin > 20 mg/dl; and serum alkaline
phosphatase > 100 IU/l. The simultaneous presence of less than three risk factors was always
associated with post-operative survival, but concomitant existence of seven or more risk
factors indicated 100% mortality. Understanding the factors related to post-operative
morbidity and mortality in patients with obstructive jaundice will better guide appropriate
surgical or non-surgical management and lead to improved survival.
PMID:
15587757
[PubMed - indexed for MEDLINE]