Original Paper Dig Surg 1999;16:204–208 Open Biliary Tract Surgery: Multivariate Analysis of Factors Affecting Mortality Elena Larraz-Mora Julio Mayol Javier Martı´nez-Sarmiento Mercedes Alvarez-Bartolomé Miguel Larroque-Derlon Jesu ´ s A. Ferna ´ ndez-Represa Servicio de Cirugı´a General y Aparato Digestivo I, Hospital Clı ´nico Universitario San Carlos, Universidad Complutense de Madrid, España Received: February 16, 1998 Accepted: November 2, 1998 Elena Larraz-Mora, MD Pinar de Doña Consuelo 3 (Urb. Huerta Vieja) Majadahonda E–28220 Madrid (Spain) Tel. +34 91 638 31 99, Fax +34 91 330 31 66 ABC Fax + 41 61 306 12 34 E-Mail karger@karger.ch www.karger.com © 1999 S. Karger AG, Basel 0253–4886/99/0163–0204$17.50/0 Accessible online at: http://BioMedNet.com/karger Key Words Biliary surgery W Common bile duct W Lithiasis W Mortality W Multivariate analysis W Logistic regression Abstract Background/Aim: The overall mortality rate in patients undergoing supraduodenal choledochotomy for benign biliary tract disease is around 3%. The aim of this study is to identify and quantify factors affecting the mortality in a group of patients undergoing open common bile duct exploration for benign biliary disease. Methods: Patients (n = 158) who underwent common bile duct exploration during a 5-year period in a teaching hospital were retro- spectively reviewed. Results: Univariate and multivar- iate statistical analyses were performed. The former identified four statistically significant variables: age (p ! 0.001), acute cholangitis on admission (p ! 0.001), heart disease (p ! 0.05), and a dilated common bile duct on preoperative ultrasound scan (p ! 0.05). Multivariate analysis identified three variables which independently increased operative mortality: age (p = 0.05), heart dis- ease (p = 0.03), and cholangitis (p = 0.008). The latter was associated with the greatest operative mortality, since it increased almost eight times the risk to die after surgical intervention. Conclusion: We conclude that an adequate perioperative cardiovascular management may be im- portant in order to improve surgical outcome. Appro- priate antibiotic prophylaxis and subsequent treatment after routine operative bile cultures may reduce septic complications and mortality. Finally, an alternative pro- cedure, such as endoscopic sphincterotomy, may be indicated in high-risk patients in order to drain the com- mon bile duct preoperatively and to decrease the risk of unresponsive biliary sepsis. Introduction Surgery for benign biliary tract disease is the most fre- quent indication for abdominal operations [1]. The over- all mortality rate for simple cholecystectomy is currently 0.17% [2]. However, common bile duct (CBD) explora- tion, performed in about 15% of the patients operated on for biliary disease [3], is associated with a 6% increase in the mortality rate [4]. After the development of minimally invasive surgery, open CBD exploration is less frequently indicated. However, this procedure is still carried out in severely ill patients with multiple choledocholithiasis in whom other alternatives have failed. Therefore, these patients and their surgeons should be provided with reli- able data to make sound decisions. Preoperative factors such as age, sex, associated medi- cal diseases, jaundice and/or acute cholangitis, and severi- ty of biliary disease have been considered responsible for