Pitt et al identified risk factors for mortality in patients undergoing biliary tract surgery from 1976 to 1979. The study antedated laparoscopic techniques, with the surgery consisting of open procedures. The authors were from the Johns Hopkins Hospital in Baltimore.
Risk factors identified:
(1) nature of biliary obstruction
(2) age of the patient
(3) serum albumin
(4) hematocrit
(5) WBC count
(6) serum bilirubin
(7) serum alkaline phosphatase
(8) serum creatinine
|
Parameter |
Finding |
Points |
|
nature of obstruction |
nonmalignant |
0 |
|
|
malignancy |
1 |
|
age |
<= 60 years of age |
0 |
|
|
> 60 years of age |
1 |
|
serum albumin |
>= 3.0 g/dL |
0 |
|
|
< 3.0 g/dL |
1 |
|
hematocrit |
>= 30% |
0 |
|
|
< 30% |
1 |
|
WBC count |
<= 10,000 per µL |
0 |
|
|
> 10,000 per µL |
1 |
|
serum bilirubin |
<= 10 mg/dL |
0 |
|
|
> 10 mg/dL |
1 |
|
serum alkaline phosphatase |
<= 3 times upper limit of normal |
0 |
|
|
> 3 times upper limit of normal |
1 |
|
serum creatinine |
<= 1.3 mg/dL |
0 |
|
|
> 1.3 mg/dL |
1 |
where:
• The serum albumin was given in g/L.
• The alkaline phosphatase was listed as a risk factor when > 100 U/L, with normal range 0 – 32 U/L.
number of risk factors present =
= SUM(points for parameters)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 8
• The more the number of risk factors, the greater the risk for the patient.
|
Number of Risk Factors |
Mortality |
|
0 to 2 |
0 |
|
3 |
4% |
|
4 |
7% |
|
5 |
44% |
|
6 |
67% |
|
7 or 8 |
100% |
Frequent complications seen in patients:
(1) renal failure
(2) bacteremia
(3) wound infection
(4) upper gastrointestinal tract hemorrhage
(5) urinary tract infection
(6) abdominal abscess
(7) pancreatitis
(8) pneumonia
Limitations:
• While the mortality rate has probably improved in the 20 years since the paper was written, all of the factors indicate severe disease or significant comorbid condition.
Specialty: Gastroenterology, Surgery, general
ICD-10: ,
