Abstract
Thirty-six clinical and laboratory parameters in 770 consecutive patients undergoing biliary tract surgery over a 3 year period were analyzed in an effort to define the patients at greatest risk. Twelve parameters had a significant correlation with hospital mortality, while multivariate analysis revealed that septic shock, malignant obstruction, serum albumin <3.0 gm%, history of hypertension, and plasma urea nitrogen >20 mg % had an independent significance in predicting postoperative mortality. The presence of more than 2 of these risk factors identified a group of patients with an 18% mortality rate. It is for this group of patients that adequate pre-operative preparation such as fluid resuscitation, prophylactic antibiotics, and nutritional support are essential. The controversial preoperative biliary drainage might be only indicated in this group of patients.
Résumé
Afin de définir une population à risque, 36 paramètres cliniques et biologiques ont été analysés chez 770 patients consécutifs opérés des voies biliaires pendant trois ans. Douze facteurs étaient significativement correlés à une mortalité hospitalière plus élevée, en analyse monofactorielle. En analyse multifactorielle, un choc septique, une obstruction d'origine maligne, une albuminémie inférieure à 3.0 gm%, des antécédents d'hypertension, et une urée sanguine supérieure à 20 mg% avaient une valeur prédictive significative de mortalité postopératoire. La présence de plus de deux de ces facteurs a correctement identifié une population pour laquelle la mortalité était de 18%. C'est donc dans cette population que les auteurs suggerent une préparation préopératoire suffisante comportant une rééquilibration hydro-électrolytique, une antibiothérapie prophylactique et une assistance nutritive. De même, le drainage biliaire préopératoire, quoique discuté, pourrait être indiqué dans ce group de patients.
Resumen
Se analizaron 36 parámetros clínicos y de laboratorio en 770 pacientes consecutivos sometidos a cirugía sobre el arbol biliar en el curso de un período de tres años con el propósito de identificar los pacientes de mayor riesgo. Doce parámetros demostraron correlación significativa en la mortalidad hospitalaria, en tanto que el análisis multivariable reveló que el shock séptico, la obstrucción maligna, un nivel sérico de albúmina menor de 3.0 g%, la historia de hipertensión y un nivel plasmático de nitrógeno ureico mayor de 20 mg% poseen significancia independiente en la predicción de la mortalidad postoperatoria. La presencia de más de dos de estos factores de riesgo identifica un grupo de pacientes con tasa de mortalidad de 18%. Es en este grupo de pacientes que es esencial una adecuada preparación preoperatoria tal como resucitación con líquidos parenterales, antibióticos profilácticos y soporte nutricional; el controvertido drenaje biliar preoperatorio puede estar indicado sólo en este grupo de pacientes.
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Su, CH., P'eng, FK. & Lui, WY. Factors affecting morbidity and mortality in biliary tract surgery. World J. Surg. 16, 536–540 (1992). https://doi.org/10.1007/BF02104465
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DOI: https://doi.org/10.1007/BF02104465