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Article: Surgery for malignant obstructive jaundice: Analysis of mortality

TitleSurgery for malignant obstructive jaundice: Analysis of mortality
Authors
Issue Date1992
PublisherMosby, Inc. The Journal's web site is located at http://www.elsevier.com/locate/surg
Citation
Surgery, 1992, v. 112 n. 5, p. 891-896 How to Cite?
AbstractSurgery on patients with malignant obstructive jaundice carries formidable morbidity and mortality rates. Clinical records of 120 consecutive patients who had a serum total bilirubin levels of 100 μmol/L or greater before exploration were analyzed retrospectively to provide guidelines for better management. Although most patients underwent bilienteric bypass to either the extrahepatic (n = 45) or intrahepatic ductal system (n = 28), resection was possible in 32 (26.7%). Complications developed in 42 patients (35%), among whom 12 (10%) required reexploration and 32 (26.7%) died within the same hospitalization. Identification of risk factors associated with hospital deaths after surgery was conducted on 84 of the 120 (group A) patients randomly selected from the entire study period. Based on multivariate analysis, age greater than 65 years, a raised serum aspartate transaminase value greater than 90 IU, and serum urea level greater than 7 mmol/L before surgery were the risk factors selected from 39 different clinical (n = 6), laboratory (n = 26), and operative (n = 7) parameters studied. The predictive value was validated in the remaining 36 patients (group B), and a high-risk patient population had been isolated. Because both serum urea and aspartate transaminase values correlated significantly with the necessity of urgent exploration, aggressive nonoperative treatment should be used to control the emergency. Alternative therapeutic options or perioperative management should be considered for the selected high-risk patients before definitive surgical biliary decompression.
Persistent Identifierhttp://hdl.handle.net/10722/172663
ISSN
2015 Impact Factor: 3.309
2015 SCImago Journal Rankings: 1.620
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorLai, ECSen_HK
dc.contributor.authorChu, KMen_HK
dc.contributor.authorLo, CYen_HK
dc.contributor.authorMok, FPTen_HK
dc.contributor.authorFan, STen_HK
dc.contributor.authorLo, CMen_HK
dc.contributor.authorWong, Jen_HK
dc.date.accessioned2012-10-30T06:24:07Z-
dc.date.available2012-10-30T06:24:07Z-
dc.date.issued1992en_HK
dc.identifier.citationSurgery, 1992, v. 112 n. 5, p. 891-896en_HK
dc.identifier.issn0039-6060en_HK
dc.identifier.urihttp://hdl.handle.net/10722/172663-
dc.description.abstractSurgery on patients with malignant obstructive jaundice carries formidable morbidity and mortality rates. Clinical records of 120 consecutive patients who had a serum total bilirubin levels of 100 μmol/L or greater before exploration were analyzed retrospectively to provide guidelines for better management. Although most patients underwent bilienteric bypass to either the extrahepatic (n = 45) or intrahepatic ductal system (n = 28), resection was possible in 32 (26.7%). Complications developed in 42 patients (35%), among whom 12 (10%) required reexploration and 32 (26.7%) died within the same hospitalization. Identification of risk factors associated with hospital deaths after surgery was conducted on 84 of the 120 (group A) patients randomly selected from the entire study period. Based on multivariate analysis, age greater than 65 years, a raised serum aspartate transaminase value greater than 90 IU, and serum urea level greater than 7 mmol/L before surgery were the risk factors selected from 39 different clinical (n = 6), laboratory (n = 26), and operative (n = 7) parameters studied. The predictive value was validated in the remaining 36 patients (group B), and a high-risk patient population had been isolated. Because both serum urea and aspartate transaminase values correlated significantly with the necessity of urgent exploration, aggressive nonoperative treatment should be used to control the emergency. Alternative therapeutic options or perioperative management should be considered for the selected high-risk patients before definitive surgical biliary decompression.en_HK
dc.languageengen_US
dc.publisherMosby, Inc. The Journal's web site is located at http://www.elsevier.com/locate/surgen_HK
dc.relation.ispartofSurgeryen_HK
dc.subject.meshAdulten_US
dc.subject.meshAgeden_US
dc.subject.meshAged, 80 And Overen_US
dc.subject.meshCholestasis - Mortality - Surgery - Therapyen_US
dc.subject.meshDrainageen_US
dc.subject.meshFemaleen_US
dc.subject.meshHumansen_US
dc.subject.meshMaleen_US
dc.subject.meshMiddle Ageden_US
dc.subject.meshPostoperative Complications - Epidemiology - Mortalityen_US
dc.subject.meshPreoperative Careen_US
dc.subject.meshRetrospective Studiesen_US
dc.subject.meshRisk Factorsen_US
dc.titleSurgery for malignant obstructive jaundice: Analysis of mortalityen_HK
dc.typeArticleen_HK
dc.identifier.emailChu, KM: chukm@hkucc.hku.hken_HK
dc.identifier.emailFan, ST: stfan@hku.hken_HK
dc.identifier.emailLo, CM: chungmlo@hkucc.hku.hken_HK
dc.identifier.emailWong, J: jwong@hkucc.hku.hken_HK
dc.identifier.authorityChu, KM=rp00435en_HK
dc.identifier.authorityFan, ST=rp00355en_HK
dc.identifier.authorityLo, CM=rp00412en_HK
dc.identifier.authorityWong, J=rp00322en_HK
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.pmid1440241-
dc.identifier.scopuseid_2-s2.0-0026458706en_HK
dc.identifier.volume112en_HK
dc.identifier.issue5en_HK
dc.identifier.spage891en_HK
dc.identifier.epage896en_HK
dc.identifier.isiWOS:A1992JX03800009-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridLai, ECS=36932159600en_HK
dc.identifier.scopusauthoridChu, KM=7402453538en_HK
dc.identifier.scopusauthoridLo, CY=16417392800en_HK
dc.identifier.scopusauthoridMok, FPT=6603786245en_HK
dc.identifier.scopusauthoridFan, ST=7402678224en_HK
dc.identifier.scopusauthoridLo, CM=7401771672en_HK
dc.identifier.scopusauthoridWong, J=8049324500en_HK

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