title: Variables associated with outcome in dogs undergoing extrahepatic biliary surgery: 60 cases (1988-2002).
abstract: OBJECTIVE
  To report clinical findings and define clinical variables associated with outcome in dogs undergoing extrahepatic biliary surgery.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Sixty dogs that had extrahepatic biliary tract surgery.
  
  
  RESULTS
  Primary diagnoses included necrotizing cholecystitis (36 dogs, 60%), pancreatitis (12 dogs, 20%), neoplasia (5 dogs, 8%), trauma (4 dogs, 7%), and gallbladder rupture from cholelithiasis without necrotizing cholecystitis (3 dogs, 5%). Bile peritonitis occurred in 19 (53%) dogs with necrotizing cholecystitis, 4 dogs with trauma, and 3 dogs with cholelithiasis without evidence of necrotizing cholecystitis. Cholecystectomy (37 dogs, 62%) and cholecystoduodenostomy (14 dogs, 23%) were the 2 most commonly performed procedures. Median hospitalization for survivors was 5 days (range, 1-15 days). There were 43 surviving dogs (72%) and 17 nonsurvivors (28%, 4 died, 13 euthanatized). Presence of septic bile peritonitis (P=.038), elevation in serum creatinine concentration (P=.003), prolonged partial thromboplastin times (PTTs; P=.003), and lower postoperative mean arterial pressures (P=.0001) were significantly associated with mortality.
  
  
  CONCLUSIONS
  Extrahepatic biliary surgery is associated with high mortality and a relatively long hospitalization time for survivors. Cholecystectomy and cholecystoduodenostomy were the most common surgical procedures to treat the 4 major biliary problems (necrotizing cholecystitis, pancreatitis, neoplasia, and trauma) observed in this cohort of dogs. The relatively high mortality rate likely reflects the underlying diseases and their effects on the animal (septic bile peritonitis, higher serum creatinine, prolonged PTT, and lower postoperative mean arterial pressure) rather than complications of surgery.
  
  
  CONCLUSIONS
  Septic bile peritonitis, preoperative elevated creatinine concentration, and immediate postoperative hypotension in dogs undergoing extrahepatic biliary tract surgery are associated with a poor clinical outcome. Adequate supportive care and monitoring in the perioperative period is critical to improve survival of dogs with extrahepatic biliary disease.
authors.affiliation: Department of Clinical Studies, Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania, 3900 Delancey Street, Philadelphia, PA 19104-6010, USA. mehlers@vet.upenn.edu
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Mehler
authors.forename: Philipp D
authors.initials: PD
authors.lastname: Mayhew
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Drobatz
authors.forename: David E
authors.initials: DE
authors.lastname: Holt
mesh_terms: D000818:Animals; D001649:Bile Duct Diseases / Q000601:surgery / Q000662:veterinary*; D002763:Cholecystectomy / Q000379:methods / Q000662:veterinary; D002764:Cholecystitis / Q000601:surgery / Q000662:veterinary; D004283:Dog Diseases / Q000453:epidemiology / Q000601:surgery*; D004285:Dogs; D005260:Female; D008297:Male; D010195:Pancreatitis / Q000601:surgery / Q000662:veterinary; D010414:Pennsylvania / Q000453:epidemiology; D011996:Records / Q000662:veterinary; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome