Surgical mortality and morbidity in malignant obstructive jaundice: a prospective multivariate analysis
Lacaine, F.; Fourtanier, G.; Fingerhut, A.; Hay, J.M.
European Journal of Surgery 161(10): 729-734
1995
ISSN/ISBN: 1102-4151 PMID: 8555340 Document Number: 450234
Objective: To construct prognostic scores using multivariate analysis for morbidity and mortality in jaundiced patients with malignant biliary obstruction. Design: Prospective study. Setting: 16 university and 12 general hospitals affiliated to the French Association for Surgical Research. Subjects: 298 consecutive patients with malignant biliary obstruction. Main outcome measures: Results of application of severity indexes for mortality and morbidity constructed from 17 variables. That for mortality was: 0.0497 times age + 0.9219 times American Society of Anesthesiologists' (ASA) grade + 0.0037 times serum bilirubin concentration minus 0. 0239 times prothrombin time + 0.0001 times white cell count minus 5.593. That for morbidity was: minus 0.7499 times ASA grade + 0.0294 times prothrombin time + 1.4220 times cause (0 = carcinoma of bile duct, 1 = pancreatic cancer) minus 1.5080 times operation (0 bypass, 1 = resection) minus 1.537. Results: The scores correctly predicted mortality in 77% and morbidity in 65% (infective morbidity in 73%). Conclusions: We recommend that when the mortality index is negative operation should be the treatment of choice, and when it is positive the patient should be advised to have non-surgical palliative treatment. When the morbidity index is negative the risk of complications is high, and when it is positive the risk is low. The application of these indexes allows for better choice of patients suitable for operative treatment of malignant biliary obstruction.