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Article: Emergency surgery for severe acute cholangitis. The high-risk patients

TitleEmergency surgery for severe acute cholangitis. The high-risk patients
Authors
Issue Date1990
PublisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.annalsofsurgery.com
Citation
Annals Of Surgery, 1990, v. 211 n. 1, p. 55-59 How to Cite?
AbstractEmergency surgery for patients with severe acute cholangitis carries formidable postoperative morbidity and mortality rates. A retrospective study was conducted on 86 consecutive patients who had exploration for the calculous obstructions to identify the high-risk population to guide better management. Septicemic shock was present in 55 patients before surgery. All patients had ductal exploration under general anesthesia. Additional procedures included cholecystectomy (n = 55), cholecystostomy (n = 5), and transhepatic intubation (n = 2). Complications and deaths occurred in 43 (50%) and 17 (20%) patients, respectively. Multivariate analysis on the 25 clinical (n = 14) and biochemcial (n = 11) parameters evaluated yield the following five predictive factors (relative risk): the presence of concomitant medical problems (4.5); pH less than 7.4 (3.5); total bilirubin more than 90 μmol/l (3.1); platelet less than 150 x 10 9/l (2.9), and serum albumin less than 30 g/L (2.9). In the presence of three or more risk factors, postoperative morbidity and mortality rates were 91% and 55%, respectively, which were significantly higher than those with two or less risk factors (34% and 6%, respectively). As thrombocytopenia developed even with transient hypotension, timely ductal decompression would improve outcome of these patients after surgery. For the high-risk population, application of nonoperative biliary drainage might be considered.
Persistent Identifierhttp://hdl.handle.net/10722/172622
ISSN
2015 Impact Factor: 8.569
2015 SCImago Journal Rankings: 4.503
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorLai, ECSen_HK
dc.contributor.authorTam, PCen_HK
dc.contributor.authorPaterson, IAen_HK
dc.contributor.authorNg, MMTen_HK
dc.contributor.authorFan, STen_HK
dc.contributor.authorChoi, TKen_HK
dc.contributor.authorWong, Jen_HK
dc.date.accessioned2012-10-30T06:23:49Z-
dc.date.available2012-10-30T06:23:49Z-
dc.date.issued1990en_HK
dc.identifier.citationAnnals Of Surgery, 1990, v. 211 n. 1, p. 55-59en_HK
dc.identifier.issn0003-4932en_HK
dc.identifier.urihttp://hdl.handle.net/10722/172622-
dc.description.abstractEmergency surgery for patients with severe acute cholangitis carries formidable postoperative morbidity and mortality rates. A retrospective study was conducted on 86 consecutive patients who had exploration for the calculous obstructions to identify the high-risk population to guide better management. Septicemic shock was present in 55 patients before surgery. All patients had ductal exploration under general anesthesia. Additional procedures included cholecystectomy (n = 55), cholecystostomy (n = 5), and transhepatic intubation (n = 2). Complications and deaths occurred in 43 (50%) and 17 (20%) patients, respectively. Multivariate analysis on the 25 clinical (n = 14) and biochemcial (n = 11) parameters evaluated yield the following five predictive factors (relative risk): the presence of concomitant medical problems (4.5); pH less than 7.4 (3.5); total bilirubin more than 90 μmol/l (3.1); platelet less than 150 x 10 9/l (2.9), and serum albumin less than 30 g/L (2.9). In the presence of three or more risk factors, postoperative morbidity and mortality rates were 91% and 55%, respectively, which were significantly higher than those with two or less risk factors (34% and 6%, respectively). As thrombocytopenia developed even with transient hypotension, timely ductal decompression would improve outcome of these patients after surgery. For the high-risk population, application of nonoperative biliary drainage might be considered.en_HK
dc.languageengen_US
dc.publisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.annalsofsurgery.comen_HK
dc.relation.ispartofAnnals of Surgeryen_HK
dc.subject.meshAcute Diseaseen_US
dc.subject.meshAdulten_US
dc.subject.meshAgeden_US
dc.subject.meshAged, 80 And Overen_US
dc.subject.meshBilirubin - Blooden_US
dc.subject.meshCholangitis - Complications - Metabolism - Mortality - Surgeryen_US
dc.subject.meshEmergenciesen_US
dc.subject.meshFemaleen_US
dc.subject.meshHumansen_US
dc.subject.meshHydrogen-Ion Concentrationen_US
dc.subject.meshMaleen_US
dc.subject.meshMiddle Ageden_US
dc.subject.meshPlatelet Counten_US
dc.subject.meshPostoperative Complications - Mortalityen_US
dc.subject.meshRetrospective Studiesen_US
dc.subject.meshRisk Factorsen_US
dc.subject.meshSerum Albumin - Metabolismen_US
dc.subject.meshShock, Septic - Etiologyen_US
dc.titleEmergency surgery for severe acute cholangitis. The high-risk patientsen_HK
dc.typeArticleen_HK
dc.identifier.emailFan, ST: stfan@hku.hken_HK
dc.identifier.emailWong, J: jwong@hkucc.hku.hken_HK
dc.identifier.authorityFan, ST=rp00355en_HK
dc.identifier.authorityWong, J=rp00322en_HK
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1097/00000658-199001000-00009-
dc.identifier.pmid2294844en_HK
dc.identifier.scopuseid_2-s2.0-0025157113en_HK
dc.identifier.volume211en_HK
dc.identifier.issue1en_HK
dc.identifier.spage55en_HK
dc.identifier.epage59en_HK
dc.identifier.isiWOS:A1990CG40500009-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridLai, ECS=36932159600en_HK
dc.identifier.scopusauthoridTam, PC=7202539419en_HK
dc.identifier.scopusauthoridPaterson, IA=7102922229en_HK
dc.identifier.scopusauthoridNg, MMT=7202076310en_HK
dc.identifier.scopusauthoridFan, ST=7402678224en_HK
dc.identifier.scopusauthoridChoi, TK=7202770029en_HK
dc.identifier.scopusauthoridWong, J=8049324500en_HK

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