Association of preoperative biliary drainage with postoperative outcome following pancreaticoduodenectomy

Objective To determine whether preoperative biliary instrumentation and preoperative biliary drainage are associated with increased morbidity and mortality rate s after pancreaticoduodenectomy. Summary Background Data Pancreaticoduodenectomy is accompanied by a considerable rate of postoperat ive complications and potential death. Controversy exists regarding the imp act of preoperative biliary instrumentation and preoperative biliary draina ge on morbidity and mortality rates after pancreaticoduodenectomy. Methods Two hundred forty consecutive cases of pancreaticoduodenectomy performed be tween January 1994 and January 1997 were analyzed. Multiple preoperative, i ntraoperative, and postoperative variables were examined. Pearson chi squar e analysis or Fisher's exact test, when appropriate, was used for univariat e comparison of ail variables. Logistic regression was used for multivariat e analysis. Results One hundred seventy-five patients (73%) underwent preoperative biliary inst rumentation (endoscopic, percutaneous, or surgical instrumentation). One hu ndred twenty-six patients (53%) underwent preoperative biliary drainage (en doscopic stents, percutaneous drains/stents, or surgical drainage). The ove rall postoperative morbidity rate after pancreaticoduodenectomy was 48% (11 4/240). Infectious complications occurred in 34% (81/240) of patients, intr aabdominal abscess occurred in 14% (33/240) of patients. The postoperative mortality rate was 5% (12/240). Preoperative biliary drainage was determine d to be the only statistically significant variable associated with complic ations (p = 0.025), infectious complications (p = 0.014), intraabdominal ab scess (p = 0.022), and postoperative death (p = 0.037). Preoperative biliar y instrumentation alone was not associated with complications, infectious c omplications, intraabdominal abscess, or postoperative death. Conclusions Preoperative biliary drainage, but not preoperative biliary instrumentation alone, is associated with increased morbidity and mortality rates in patie nts undergoing pancreaticoduodenectomy. This suggests that preoperative bil iary drainage should be avoided whenever possible in patients with potentia lly resectable pancreatic and peripancreatic lesions. Such a change in curr ent preoperative management may improve patient outcome after pancreaticodu odenectomy.