title: Preoperative cholangitis during biliary drainage increases the incidence of postoperative severe complications after pancreaticoduodenectomy.
abstract: BACKGROUND
  It remains controversial how preoperative biliary drainage affects occurrence of severe complications after pancreaticoduodenectomy (PD).
  
  
  METHODS
  One hundred twenty-seven patients (60 external drainage and 67 internal drainage) required biliary drainage before PD were retrospectively reviewed.
  
  
  RESULTS
  Preoperative cholangitis in internal drainage group (22.4%) occurred significantly more often than in external drainage group (1.7%; P < .001). The incidence of severe complications (grade III or more) was significantly higher in patients with cholangitis (62.5%) than in those without it (25.2%; P = .002). The incidence of delayed gastric emptying was significantly higher in patients with cholangitis (31.2%) than in those without it (5.4%; P = .001). A multivariate logistic regression analysis revealed that preoperative cholangitis (odds ratio 4.61, 95% confidence interval 1.3 to 16.5; P = .019) was the independent risk factor for severe complications after PD.
  
  
  CONCLUSIONS
  Preoperative cholangitis during biliary drainage significantly increases incidence of severe complications after PD.
authors: Second Department of Surgery, Wakayama Medical University School of Medicine, 811-1 Kimiidera, Wakayama 641-8510, Japan.
authors: Yuji
authors: Y
authors: Kitahata
authors: Second Department of Surgery, Wakayama Medical University School of Medicine, 811-1 Kimiidera, Wakayama 641-8510, Japan.
authors: Manabu
authors: M
authors: Kawai
authors: Second Department of Surgery, Wakayama Medical University School of Medicine, 811-1 Kimiidera, Wakayama 641-8510, Japan.
authors: Masaji
authors: M
authors: Tani
authors: Second Department of Surgery, Wakayama Medical University School of Medicine, 811-1 Kimiidera, Wakayama 641-8510, Japan.
authors: Seiko
authors: S
authors: Hirono
authors: Second Department of Surgery, Wakayama Medical University School of Medicine, 811-1 Kimiidera, Wakayama 641-8510, Japan.
authors: Ken-ichi
authors: K
authors: Okada
authors: Second Department of Surgery, Wakayama Medical University School of Medicine, 811-1 Kimiidera, Wakayama 641-8510, Japan.
authors: Motoki
authors: M
authors: Miyazawa
authors: Second Department of Surgery, Wakayama Medical University School of Medicine, 811-1 Kimiidera, Wakayama 641-8510, Japan.
authors: Atsushi
authors: A
authors: Shimizu
authors: Second Department of Surgery, Wakayama Medical University School of Medicine, 811-1 Kimiidera, Wakayama 641-8510, Japan. Electronic address: yamaue-h@wakayama-med.ac.jp.
authors: Hiroki
authors: H
authors: Yamaue
mesh_terms: D000368:Aged; D002761:Cholangitis / Q000150:complications*; D004322:Drainage / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D041781:Jaundice, Obstructive / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011300:Preoperative Care / Q000009:adverse effects* / Q000379:methods; D057234:Preoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
keywords: Biliary drainage; Cholangitis; Delayed gastric emptying; Pancreaticoduodenectomy; Postoperative complications; Wound infection