Csendes et al determined risk factors for mortality in patients having surgery for common bile duct stones with and without acute suppurative cholangitis. The authors are from the University of Chile in Santiago.
Procedure: open laparotomy
Exclusions: patients with intrahepatic stones, benign strictures, malignant tumors of the biliary tract, or cholecystoenteric fistula.
Groups separated by appearance of bile aspirated at surgery:
(1) nonsuppurative: bile clear
(2) suppurative: bile turbid, or frank pus
Shared Factors Affecting Surgery With or Without Cholangitis
|
Parameter |
Finding |
Points |
|
age |
> 60 years |
1 |
|
|
<= 60 years |
0 |
|
concomitant disease |
present |
1 |
|
|
absent |
0 |
|
hemoglobin |
< 11 g/dL |
1 |
|
|
>= 11 g/dL |
0 |
|
blood urea nitrogen |
> 10.7 mmol/L |
1 |
|
|
<= 10.7 mmol/L |
0 |
|
diameter of common bile duct |
> 20 mm |
1 |
|
|
<= 20 mm |
0 |
where:
• I am assuming that blood urea nitrogen in SIU refers to blood urea (while blood urea nitrogen can be expressed in mmol/L, the usual reporting is for urea).
• The types of concomitant disease(s) are not stated. Acute renal failure might be counted twice, together with an increase BUN.
Additional Factors Affecting Surgery With Acute Cholangitis
|
Parameter |
Finding |
Points |
|
duration of colic |
> 8 days |
1 |
|
|
<= 8 days |
0 |
|
jaundice before or at admission |
present |
1 |
|
|
absent |
0 |
|
mental confusion |
present |
1 |
|
|
absent |
0 |
|
shock at admission |
present |
1 |
|
|
absent |
0 |
|
blood glucose |
> 9.9 mmol/L |
1 |
|
|
<= 9.9 mmol/L |
0 |
|
left deviation |
> 16% |
1 |
|
|
<= 16% |
0 |
|
prothrombin time |
> 20 seconds |
1 |
|
|
<= 20 seconds |
0 |
|
alkaline phosphatase |
> 200 U/L |
1 |
|
|
<= 200 U/L |
0 |
where:
• Left deviation is taken to mean left axis deviation of the heart.
• The reference ranges for the laboratory tests are not given.
number of risk factors =
= SUM(points for shared factors) + SUM(points for additional factors if acute cholangitis present)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors in the absence of cholangitis: 5
• maximum number of risk factors in the presence of acute suppurative cholangitis: 13
|
Acute Cholangitis |
Number of Risk Factors |
Mortality Rate |
Severity of Disease |
|
absent |
0 – 2 |
0.7% |
mild |
|
|
3 – 4 |
21% |
severe |
|
present |
0 – 2 |
0% |
mild |
|
|
3 – 4 |
5.6% |
moderate |
|
|
5 - 9 |
27.5% (up to 50%) |
severe |
from Tables 8 & 9 page 657
Limitations:
• The mortality rate for laparoscopic procedures might be different, However, many of the risk factors would tend to favor conversion to an open procedure.
Specialty: Infectious Diseases, Gastroenterology
