title: Rate of bilirubin decrease as a risk predictor in hepato-biliary-pancreatic surgery.
abstract: OBJECTIVE
  Although percutaneous transhepatic biliary drainage is widely performed for jaundice reduction, the clinical significance and mechanism responsible for delayed decrease of the bilirubin level remains unclarified.
  
  
  METHODS
  The rate of bilirubin decrease was estimated in 104 consecutive patients who underwent drainage. Morbidity and mortality after major and minor operations for hepato-biliary-pancreatic diseases in groups showing slow and rapid bilirubin decrease were estimated. The risk factors for slow bilirubin decrease were also examined by uni- and multivariate analyses.
  
  
  RESULTS
  A statistically significant difference between the slow and rapid bilirubin decrease groups was found only in the morbidity rates of major surgery (73% vs 28%, p < 0.05). Univariate analysis showed that the longer interval from onset of jaundice to drainage, the use of multiple catheters for jaundice reduction, and advanced age were significant risk factors for slow bilirubin decrease. These factors were found to be independent by multivariate analysis (p < 0.05)
  
  
  CONCLUSIONS
  A slow rate of jaundice reduction is a predictor of high risk in major surgery. It can be attributed to 3 factors; longer term of undrained jaundice, multiple biliary drainage, and age. Careful post-operative management is required when major surgery is scheduled for patients with these risk-predictive factors.
authors.affiliation: Department of Surgery, Graduate School of Medicine, University of Tokyo, Japan. SANO-2SU@h.u-tokyo.ac.jp
authors.forename: K
authors.initials: K
authors.lastname: Sano
authors.forename: K
authors.initials: K
authors.lastname: Kubota
authors.forename: Y
authors.initials: Y
authors.lastname: Bandai
authors.forename: M
authors.initials: M
authors.lastname: Makuuchi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D001663:Bilirubin / Q000097:blood*; D002779:Cholestasis / Q000097:blood / Q000209:etiology / Q000601:surgery*; D004322:Drainage / Q000379:methods; D005260:Female; D005704:Gallbladder; D006498:Hepatectomy / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects* / Q000401:mortality; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D001663:Bilirubin