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 biliary obstruction.

DESIGN

Prospective study.

SETTING

16 university and 12 general hospitals affiliated to the French Association for Surgical Research.

MAIN OUTCOME MEASURES

Results of application of severity indexes for mortality and morbidity constructed from 17 variables. That for mortality was: 0.0497 x age + 0.9219 x American Society of Anesthesiologists' (ASA) grade + 0.0037 x serum bilirubin concentration minus 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 prothrombin time + 1.4220 x cause (0 = carcinoma of bile duct, 1 = pancreatic cancer) minus 1.5080 x 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.