• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of annsurgLink to Publisher's site
Ann Surg. May 1985; 201(5): 545–553.
PMCID: PMC1250755

Does preoperative percutaneous biliary drainage reduce operative risk or increase hospital cost?

Abstract

Despite recent advances in perioperative support care, surgery for obstructive jaundice is still associated with significant morbidity and mortality. For this reason, preoperative percutaneous transhepatic drainage (PTD) has been recommended for these patients. This method of management, however, has only been supported by retrospective and nonrandomized studies. Therefore, a prospective, randomized study was performed to determine the effect of preoperative PTD on operative mortality, morbidity, hospital stay, and hospital cost. Thirty-day mortality was 8.1% among 37 patients undergoing preoperative PTD, compared to 5.3% for 38 patients who went to surgery without preoperative drainage. Overall morbidity was also slightly, but not significantly, higher in patients who underwent preoperative PTD, (57% versus 53%). However, total hospital stay was significantly longer (p less than 0.005) in the PTD group (31.4 days versus 23.1 days). The cost of this excess hospitalization and the PTD procedure at our university medical center was over +8000 per patient. The authors conclude that preoperative PTD does not reduce operative risk but does increase hospital cost and, therefore, should not be performed routinely.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.5M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Pitt HA, Cameron JL, Postier RG, Gadacz TR. Factors affecting mortality in biliary tract surgery. Am J Surg. 1981 Jan;141(1):66–72. [PubMed]
  • Nakayama T, Ikeda A, Okuda K. Percutaneous transhepatic drainage of the biliary tract: technique and results in 104 cases. Gastroenterology. 1978 Mar;74(3):554–559. [PubMed]
  • Takada T, Hanyu F, Kobayashi S, Uchida Y. Percutaneous transhepatic cholangial drainage: direct approach under fluoroscopic control. J Surg Oncol. 1976;8(1):83–97. [PubMed]
  • Braasch JW, Gray BN. Considerations that lower pancreatoduodenectomy mortality. Am J Surg. 1977 Apr;133(4):480–484. [PubMed]
  • Brooks JR, Culebras JM. Cancer of the pancreas. Palliative operation, Whipple procedure, or total pancreatectomy? Am J Surg. 1976 Apr;131(4):516–520. [PubMed]
  • Denning DA, Ellison EC, Carey LC. Preoperative percutaneous transhepatic biliary decompression lowers operative morbidity in patients with obstructive jaundice. Am J Surg. 1981 Jan;141(1):61–65. [PubMed]
  • Gundry SR, Strodel WE, Knol JA, Eckhauser FE, Thompson NW. Efficacy of preoperative biliary tract decompression in patients with obstructive jaundice. Arch Surg. 1984 Jun;119(6):703–708. [PubMed]
  • Blamey SL, Fearon KC, Gilmour WH, Osborne DH, Carter DC. Prediction of risk in biliary surgery. Br J Surg. 1983 Sep;70(9):535–538. [PubMed]
  • Dixon JM, Armstrong CP, Duffy SW, Davies GC. Factors affecting morbidity and mortality after surgery for obstructive jaundice: a review of 373 patients. Gut. 1983 Sep;24(9):845–852. [PMC free article] [PubMed]
  • Hunt DR. The identification of risk factors and their application to the management of obstructive jaundice. Aust N Z J Surg. 1980 Oct;50(5):476–480. [PubMed]
  • Bonnel D, Ferrucci JT, Jr, Mueller PR, Lacaine F, Peterson HF. Surgical and radiological decompression in malignant biliary obstruction: a retrospective study using multivariate risk factor analysis. Radiology. 1984 Aug;152(2):347–351. [PubMed]
  • Pollock TW, Ring ER, Oleaga JA, Freiman DB, Mullen JL, Rosato EF. Percutaneous decompression of benign and malignant biliary obstruction. Arch Surg. 1979 Feb;114(2):148–151. [PubMed]
  • Smale BF, Ring EJ, Freiman DB, Oleaga JA, Reichman R, Mullen JL, Rosato EF. Successful long-term percutaneous decompression of the biliary tract. Am J Surg. 1981 Jan;141(1):73–76. [PubMed]
  • Dooley JS, Dick R, Olney J, Sherlock S. Non-surgical treatment of biliary obstruction. Lancet. 1979 Nov 17;2(8151):1040–1044. [PubMed]
  • Ferrucci JT, Jr, Mueller PR, Harbin WP. Percutaneous transhepatic biliary drainage: technique, results, and applications. Radiology. 1980 Apr;135(1):1–13. [PubMed]
  • Hansson JA, Hoevels J, Simert G, Tylén U, Vang J. Clinical aspects of nonsurgical percutaneous transhepatic bile drainage in obstructive lesions of the extrahepatic bile ducts. Ann Surg. 1979 Jan;189(1):58–61. [PMC free article] [PubMed]
  • Tylén U, Hoevels J, Vang J. Percutaneous transhepatic cholangiography with external drainage of obstructive biliary lesions. Surg Gynecol Obstet. 1977 Jan;144(1):13–18. [PubMed]
  • Berquist TH, May GR, Johnson CM, Adson MA, Thistle JL. Percutaneous biliary decompression: internal and external drainage in 50 patients. AJR Am J Roentgenol. 1981 May;136(5):901–906. [PubMed]
  • Carrasco CH, Zornoza J, Bechtel WJ. Malignant biliary obstruction: complications of percutaneous biliary drainage. Radiology. 1984 Aug;152(2):343–346. [PubMed]
  • Clark RA, Mitchell SE, Colley DP, Alexander E. Percutaneous catheter biliary decompression. AJR Am J Roentgenol. 1981 Sep;137(3):503–509. [PubMed]
  • Hatfield AR, Tobias R, Terblanche J, Girdwood AH, Fataar S, Harries-Jones R, Kernoff L, Marks IN. Preoperative external biliary drainage in obstructive jaundice. A prospective controlled clinical trial. Lancet. 1982 Oct 23;2(8304):896–899. [PubMed]
  • McPherson GA, Benjamin IS, Habib NA, Bowley NB, Blumgart LH. Percutaneous transhepatic drainage in obstructive jaundice: advantages and problems. Br J Surg. 1982 May;69(5):261–264. [PubMed]
  • McPherson GA, Benjamin IS, Hodgson HJ, Bowley NB, Allison DJ, Blumgart LH. Pre-operative percutaneous transhepatic biliary drainage: the results of a controlled trial. Br J Surg. 1984 May;71(5):371–375. [PubMed]
  • Stambuk EC, Pitt HA, Pais SO, Mann LL, Lois JF, Gomes AS. Percutaneous transhepatic drainage. Risks and benefits. Arch Surg. 1983 Dec;118(12):1388–1394. [PubMed]
  • Gobien RP, Stanley JH, Soucek CD, Anderson MC, Vujic I, Gobien BS. Routine preoperative biliary drainage: effect on management of obstructive jaundice. Radiology. 1984 Aug;152(2):353–356. [PubMed]
  • Norlander A, Kalin B, Sundblad R. Effect of percutaneous transhepatic drainage upon liver function and postoperative mortality. Surg Gynecol Obstet. 1982 Aug;155(2):161–166. [PubMed]
  • Leung JW, Emery R, Cotton PB, Russell RC, Vallon AG, Mason RR. Management of malignant obstructive jaundice at The Middlesex Hospital. Br J Surg. 1983 Oct;70(10):584–586. [PubMed]
  • Nilsson U, Evander A, Ihse I, Lunderquist A, Mocibob A. Percutaneous transhepatic cholangiography and drainage. Risks and complications. Acta Radiol Diagn (Stockh) 1983;24(6):433–439. [PubMed]
  • Koyama K, Takagi Y, Ito K, Sato T. Experimental and clinical studies on the effect of biliary drainage in obstructive jaundice. Am J Surg. 1981 Aug;142(2):293–299. [PubMed]
  • Fargion SR, Podda M, Cappellini MD, Fiorelli G. Immunità cellulare nelle colestasi intra ed extra-epatiche. Minerva Gastroenterol. 1976 Jul-Sep;22(3):261–265. [PubMed]
  • Gianni L, Di Padova F, Zuin M, Podda M. Bile acid-induced inhibition of the lymphoproliferative response to phytohemagglutinin and pokeweed mitogen: an in vitro study. Gastroenterology. 1980 Feb;78(2):231–235. [PubMed]
  • Hunt DR, Allison ME, Prentice CR, Blumgart LH. Endotoxemia, disturbance of coagulation, and obstructive jaundice. Am J Surg. 1982 Sep;144(3):325–329. [PubMed]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

Formats:

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...

Links

  • Cited in Books
    Cited in Books
    PubMed Central articles cited in books
  • MedGen
    MedGen
    Related information in MedGen
  • PubMed
    PubMed
    PubMed citations for these articles