title: Predictors of outcome among patients with obstructive jaundice at Bugando Medical Centre in north-western Tanzania.
abstract: Despite recent advances both in preoperative diagnosis and postoperative care, obstructive jaundice still contributes significantly to high morbidity and mortality. A prospective study was undertaken to identify predictors of outcome among patients with obstructive jaundice at Bugando Medical Centre in north-western Tanzania. A total of 138 patients were studied. The male to female ratio was 1:1.6. The median age of patients was 58 years. Patients with malignant obstructive jaundice were older than those of benign type (P < 0.001). Ca head of pancreas (65.1%) was the commonest malignant cause of jaundice where as choledocholithiasis (51.9%) was the commonest benign cause. Twelve (9.7%) patients were HIV positive with a median CD 4+ count of 342 cells/μl. A total of 130 (94.2%) patients underwent surgical treatment and the remaining 8 (5.8%) patients were unfit for surgery. The complication rate was 30.4% mainly due to surgical site infections and it was significantly influenced by malignant causes, WBC count > 10 X 109/l and HIV infection with low CD4 (200 cells/μl) (p < 0.0001). The median hospital stay and mortality rate were 18 days and 20.3%, respectively. A low haematocrit and presence of postoperative complications were the main predictors of the hospital stay (P < 0.001), whereas age > 60 years, prolonged duration of jaundice, malignant causes, high bilirubin levels, HIV infection with low CD4+ count (200 cells/ μl) and presence of postoperative complications significantly predicted mortality (P < 0.001). In conclusion, our study highlighted the important factors that predict the outcome of patients presenting with obstructive jaundice at BMC; therefore attention should be focused to these factors so as to improve the outcome of these patients.
authors.affiliation: Department of Surgery, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania.
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Mabula
authors.forename: Japhet M
authors.initials: JM
authors.lastname: Gilyoma
authors.forename: Mabula D
authors.initials: MD
authors.lastname: Mchembe
authors.forename: Hyasinta
authors.initials: H
authors.lastname: Jaka
authors.forename: Erasmus
authors.initials: E
authors.lastname: Kamugisha
authors.forename: Benson
authors.initials: B
authors.lastname: Kidenya
authors.forename: Peter F
authors.initials: PF
authors.lastname: Rambau
authors.forename: Phillipo L
authors.initials: PL
authors.lastname: Chalya
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013636:Tanzania / Q000453:epidemiology; D016896:Treatment Outcome