Analysis Of Preoperative Risk Factors Affecting Mortality And Morbidity In Patients After Surgery Of Biliary Tract: A Retrospective Study

摘要

14 preoperative risk factors were evaluated in 78 patients retrospectively which have an effect on postoperative mortality and morbidity undergoing surgery of biliary tract. Risk factors considered were 5 clinical (age, disease, fever, history of jaundice, history of diabetes) and 9 biochemical (hematocrit, total leucocyte count, raised prothrombin time, serum creatinine, serum albumin, serum bilirubin, AST, ALT, ALP). The type of surgery performed was also taken into consideration. Type 1 involved CBD exploration and T tube drainage; Type 2 involved biliary enteric anastomosis; Type 3 involved major surgeries like Whipple's procedure. Patients undergoing Type 3 surgery involving resection of pancreas were at the highest risk of mortality (p value of <0.001). Preoperative risk factors - history of jaundice >21 days (p value <0.02), hematocrit of <30% (p value <0.0005), raised prothrombin time of >1.5 times control (p value <0.05) and a serum albumin of <3.0 g/dl (p value <0.05) contributed significantly to postoperative mortality. There was a proportionately higher mortality in patients >60 years of age and having malignant disease but it was not statistically significant. The complications seen most frequently after biliary surgery in order of frequency were wound infection (21%), pulmonary complications (18%), sepsis (11%), renal failure (7%), urinary tract infection (7%), GI hemorrhage (3%) and abdominal abscess (3%). Postoperative renal failure and sepsis were highly predictive of mortality. Mortality increased as the number of risk factors increased. Surgery after treatment of correctable risk factors decreased postoperative mortality and morbidity. Introduction Since ages the high mortality and morbidity of the management of jaundiced patient were due to difficulties in diagnosis and due to increased complications of surgery in jaundiced patients.1,2,3,4,5,6,7,8,9,10,11,12 In present times, with the advent of modern imaging modalities, advanced techniques in surgery and perioperative care, the management of jaundiced patients is revolutionized.13,14,15,16 In this study we have tried to identify certain preoperative risk factors in jaundiced patients who undergo surgery of the biliary tract and correlate them with postoperative mortality and morbidity. With proper assessment these factors can be controlled preoperatively leading to a better outcome of surgery. Materials And Methods 78 Patients were selected who underwent surgery of biliary tract from January 2003 To February 2006. The various risk factors evaluated in these patients are listed in Table 1.