Obstructive jaundice in Iran: factors affecting early outcome

Abstract

Background: Understanding any factors which influence the morbidity and mortality in patients with obstructive jaundice in each society will better guide appropriate management and lead to improved survival. This study aimed to assess baseline etiologies, clinical manifestations, diagnostic results, and morbidity and mortality related to obstructive jaundice in Iranian patients.

Methods: The hospital recorded files of 133 patients with the final diagnosis of obstructive jaundice who had been admitted to the Taleqhani Hospital in Tehran between January 2001 and September 2004 were reviewed.

Results: The most common etiologies of obstructive jaundices were neoplasia and then common bile duct stone in the two genders. The results of ultrasonography were positive in less than half of the patients. However, the most positive results were related to endoscopic retrograde cholangiopancreatography (ERCP). The in-hospital mortality rate in patients less than 50 years old and elderly patients was 0% and 6.76%, respectively. The in-hospital morbidity rate was 2.25% and 7.51%, respectively in both patients and it was commonly related to infection of ulcer (44.46%), pneumonia (14.75%), myocardial infarction (14.75%), and subdiaphragmatic abscess (11.29%). In patients with a diagnosis of benign obstruction, only one patient died of severe sepsis. In malignant group, preoperative characteristics, such as weight loss (P=0.015) and serum bilirubin concentration more than 16 mg/dl and postoperative complications, such as sepsis (P<0.001), cardiac arrest (P<0.001), and hepatic coma (P<0.001) were main predictors for the in-hospital mortality rate.

Conclusion: Although the mortality and morbidity of obstructive jaundice in our study are less than those in other studies, the determination of preoperative clinical and laboratory indices and postoperative complications of patients is needed for the control of mortality and morbidity rate.