Perioperative outcomes among patients undergoing open biliary bypass surgery for malignant biliary obstruction in a low resource setting: a multi-centre prospective cohort
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Date
2023-07
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Addis Ababa University
Abstract
Introduction: Obstructive jaundice is the most common symptom of malignant
diseases of the extrahepatic biliary system and necessitates either non-operative or
operative biliary bypass. Because of percutaneous and endoscopic approaches, the use
of palliative surgical procedures has decreased in recent years. However, in resource-
limited situations, open biliary bypasses remain a viable option. This study aimed to
identify factors associated with adverse perioperative outcomes following open biliary
bypass.
Methods: From June 2022 to May 2023, 69 patients underwent open biliary bypass for
malignant biliary obstruction. Postoperative morbidity and mortality within 30 days of
surgery were assessed. A Kaplan-Meier was used for categorical variables, and a log-
rank test was used to determine the statistically significant difference between
variables. A Cox regression analysis was conducted to identify factors associated to
time to develop complications.
Results: The hazard of developing complications among those with preoperative
cholangitis was 2.49 times higher than those without preoperative cholangitis (HR 2.49,
95% CI [1.06, 5.84]). For every hour increment in the length of surgery, the hazard of
getting complications increased by 2.47 times (HR 2.47, 95% CI [1.28, 4.77]). As
serum bilirubin increased by 1mg/dl, the hazard of developing complications increased
by 14% (HR 1.14, 95% CI [1.03, 1.17]).
Conclusion: Patients who had long operation times, preoperative cholangitis, and
elevated total bilirubin levels are at increased risk for poor perioperative outcomes.
Clinicians may use these results to optimize these patients to decrease their elevated
risk of serious morbidity and mortality
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Keywords
Malignant biliary obstruction, Open biliary bypass, Perioperative outcomes.