INR and not bilirubin levels predict postoperative morbidity in patients with malignant obstructive jaundice

Florian Scheufele, Lena Aichinger, Carsten Jäger, Ihsan Ekin Demir, Stephan Schorn, Elke Demir, Mine Sargut, Helmut Friess, Güralp O. Ceyhan

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Background: There are no established predictors for deciding between upfront surgery and PBD in pancreatic head malignancy. Once PBD is present, the ideal drainage-time remains elusive. The aim was, to identify predictors in jaundiced patients and ideal PBD-duration. Methods: Analysis of 304 patients with pancreatic head malignancy (56% with PBD, n = 170) undergoing pancreaticoduodenectomy was performed. Postoperative morbidity and survival were analyzed. Results: Postoperative complications increased after PBD (98.2% vs. 88.8%; p < 0.001). Patients with PBD received more postoperative antibiotics (42.4% vs. 21.6%; p < 0.001) and wound infections were increased (21.4% vs. 9.4%; p = 0.006). INR predicted postoperative morbidity (p = 0.026), whereas serum-bilirubin (p = 0.708), leucocytes (p = 0.158) and MELD-score (p = 0.444) had no impact. Complications were not different between long (>4 weeks) and short (<4 weeks) PBD-duration (p = 0.608). No life-threatening complications (CDIV + V) occurred after long drainage (0.0% vs. 8.9%; p = 0.028) and long-term survival was not compromised. Conclusions: INR is a suitable predictor for postoperative outcome, while serum-bilirubin levels had no predictive value. The INR can help deciding between PBD and upfront surgery. If PBD is inevitable, drainage duration of >4 weeks reduced major complications. Category: Clinical study.

Original languageEnglish
Pages (from-to)976-982
Number of pages7
JournalAmerican Journal of Surgery
Volume222
Issue number5
DOIs
StatePublished - Nov 2021
Externally publishedYes

Keywords

  • Bilirubin
  • Complications
  • INR
  • Intra-abdominal abscess
  • Morbidity
  • Mortality
  • Pancreatic cancer
  • Pancreatic fistula
  • Preoperative biliary drainage
  • Wound infection

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