SURGICAL MORTALITY AND MORBIDITY IN MALIGNANT OBSTRUCTIVE-JAUNDICE - A PROSPECTIVE MULTIVARIATE-ANALYSIS

Objective: To construct prognostic scores using multivariate analysis for morbidity and mortality in jaundiced patients with malignant bilia ry 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 o bstruction. Main outcome measures: Results of application of severity indexes for mortality and morbidity constructed from 17 variables. Tha t for mortality was: 0.0497 x age + 0.9219 x American Society of Anest hesiologists' (ASA) grade + 0.0037 x serum bilirubin concentration min us 0.0239 x prothrombin time + 0.0001 x white cell count minus 5.593. That for morbidity was: minus 0.7499 x ASA grade + 0.0294 x prothrombi n time + 1.4220 x cause (0 = carcinoma of bile duct, 1 = pancreatic ca ncer) minus 1.5080 x operation (0 = bypass, 1 = resection) minus 1.537 . Results: The scores correctly predicted mortality in 77% and morbidi ty in 65% (infective morbidity in 73%). Conclusions: We recommend that when the mortality index is negative operation should be the treatmen t of choice, and when it is positive the patient should be advised to have non-surgical palliative treatment. When the morbidity index is ne gative 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 obs truction.