Factors affecting post-operative mortality in malignant biliary tract obstruction

BACKGROUND/AIMS: Although malignant obstruction, itself, is a significant r isk factor associated with post-operative mortality, factors affecting mort ality in the surgery of malignant obstruction have not been thoroughly stud ied in the literature. METHODOLOGY: In order to identify independent risk factors which might be a ssociated with an increase in post-operative mortality in patients with mal ignant biliary obstruction, 24 clinical and laboratory parameters in 52 pat ients undergoing biliary tract surgery were analyzed retrospectively. RESULTS: Simple regression revealed 24 factors with prognostic significance , but multivariate analysis detected only 3 factors with independent signif icance in predicting mortality (cholangitis, weight loss of 10kg or more an d operative or post-operative blood transfusion). The presence of 2 of thes e risk factors identified a group of patients with an 37% mortality rate. CONCLUSIONS: The results of this study show that the presence of pre-operat ive cholangitis, marked weight loss, and operative and post-operative blood transfusion are associated with high postoperative mortality. The major ch allenge is the prevention of cholangitis in high-risk patients, improvement of the nutritional status of the patients, and avoidance of unnecessary bl ood transfusions.