Risk factors for morbidity and mortality following gastroenterostomy.
BACKGROUND
Morbidity and mortality following traditional surgical treatment of gastric outlet obstruction is high. The aim of this work was to identify risk factors predictive of postoperative complications and mortality following gastroenterostomy.


METHODS
One-hundred sixty-five consecutive patients subjected to open gastroenterostomy from January 1996 through July 2003 were included. Data on vital signs and operative variables were retrieved from medical records and recorded retrospectively. Risk factors for postoperative complications and mortality within 30 days after operation were analyzed with multiple logistic regression.


RESULTS
The 30-day complication and death rates were higher after emergency operations (80% and 60%) than after elective operations (32% and 25%). A multivariate analysis disclosed that hypoalbuminemia (< or = 32 g/l), comorbidity, high age, and hyponatremia (< 135 micromol/l) were significantly associated with postoperative death, whereas hypoalbuminemia, comorbidity, high age, and emergency operation were predictors of postoperative complications.


CONCLUSIONS
Complications and mortality after gastroenterostomy due to gastric outlet obstruction are associated with modifiable and non-modifiable risk factors. Prior to surgery means should be taken to correct low albumin and sodium levels to prevent complications. In addition, the surgeon should consider alternative treatment modalities including laparoscopic gastroenterostomy, self-expanding metallic stents, or tube gastrostomy to relieve or palliate gastric outlet obstruction.
Poulsen
Martin
M
Department of Surgery, Bispebjerg Hospital, Bispebjerg Bakke 23, DK-2400, Copenhagen NV, Denmark. martinp@dadlnet.dk
Trezza
Mauro
M
Atimash
Ghayyath H
GH
Sorensen
Lars T
LT
Kallehave
Finn
F
Hemmingsen
Ulla
U
Jorgensen
Lars N
LN
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015331:Cohort Studies; D016001:Confidence Intervals; D003718:Denmark; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D004638:Emergency Treatment / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D017219:Gastric Outlet Obstruction / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D005763:Gastroenterostomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality*; D011336:Probability; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis; D016896:Treatment Outcome