COMPLICATIONS AFTER ELECTIVE GASTRIC RESECTION FOR DUODENAL-ULCER MULTIVARIATE-ANALYSIS OF RISK-FACTORS

The records of 545 consecutive patients, who underwent elective Billro th II gastric resection for pyloric or duodenal ulcer were examined re trospectively to identify a group of high-risk patients for life threa tening postoperative complications or death. Thirty-two preoperative c linical, endoscopic, surgical and haematological variables were analyz ed by stepwise logistic regression. Major complications occurred in 39 patients (7%) and eight patients (1.5%) died. The patient characteris tics associated with the major complications and death were liver cirr hosis (Odds ratio 6.7 95% Confidence interval 1.3-33.8), white blood c ell count > 10,000/mm(3) (Odds ratio 5.5 95% Confidence interval 1.7-1 7.3), previous abdominal surgery (Odds ratio 4.6 95% Confidence interv al 1.7-12.1), and ulcer penetrating contiguous structures (Odds ratio 3.3 95% Confidence interval 1.2-8.9). There was no statistically signi ficant interaction between the above risk factors in causing complicat ions or death. It can be concluded that even if only one of these four risk factors is present in patients undergoing elective surgery for d uodenal ulcer a riskless technique, such as proximal gastric vagotomy, should be used instead of Billroth II gastric resection.