Prediction Of Risk In Biliary Surgery

Objective: To identify the independent risk factors which might be associated with increased postoperative morbidity and mortality rates following biliary surgery.Methods: Retrospective analysis was performed in a consecutive series of 457 patients undergone biliary tract surgery. Multiple preoperative and intraoperative variables were examined. Pearson chi-square analysis or Fisher's exact test, when appropriate, was used for univariate comparison of all variables. Logistic stepwise regression was taken for multivariate analysis.Results: Stepwise logistic regression revealed that seven parameters were independent significant in predicting postoperative mortality and morbidity, which are male, age over 60 years, hypoalbuminemia, hyperbilirubinemia, operation duration longer than 4 hours, higher blood urea nitrogen and lower haematocrit. Risk factors (over 2) was found to be associated with increased postoperative morbidity (28.13%) and mortality (16.67%) compared with those less than 2 risk factors (P<0.0001). Mortality and morbidity rates increased proportionally in patients with three or more risk factors. Mortality in malignant biliary surgery was associated with hyponatremia that was positive correlated with hyperbilirubinemia and leukocytosis.Conclusions: The postoperative morbidity and mortality increased with the increasing risk factors number, especially when the risk factors are more than two. Significant hyponatremia is an importent risk factor in malignant biliary obstruction. It is suggested that the preoperative correction of hypoalbuminemia and hyponatremia as well as adequate nutritional supporting in peri-operative period, and the proper choosing of operation procedure might decreas morbidity and mortality in biliary tract surgery. Furthermore, the prevention of renal failure in patients with biliary obstruction is also important.