Obstructive jaundice in a referral unit: surgical practice and risk factors

A series of 46 consecutive patients with obstructive jaundice have been referred to a surgical unit with a special interest in hepatobiliary surgery. The cases were evenly divided between benign and malignant causes. The hospital mortality was 13% (six cases), and the mortality was also evenly divided between the two subgroups. A scoring system has been devised to rate 12 easily measured clinical and pathological parameters, and a regression analysis used to measure the contribution made by each parameter to hospital morbidity and mortality and to later mortality over a 5 year period. Previous bile duct trauma and liver damage were the major determinants of hospital morbidity, while bile duct trauma, liver disease, acute pancreatitis and increasing age were the significant determinants of hospital mortality. Malignancy and cirrhosis determined late mortality. A plea is made for the early referral of high risk patients to specialized units, particularly when bile duct trauma is involved.