PERIOPERATIVE OUTCOMES AMONG PATIENTS UNDERGOING OPEN BILIARY BYPASS SURGERY FOR MALIGNANT BILIARY OBSTRUCTION IN A LOW RESOURCE SETTING: A MULTI-CENTER PROSPECTIVE COHORT STUDY josephsol87@gmail.com

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PERIOPERATIVE OUTCOMES AMONG PATIENTS UNDERGOING OPEN BILIARY BYPASS SURGERY FOR MALIGNANT BILIARY OBSTRUCTION IN A LOW RESOURCE SETTING: A MULTI-CENTER PROSPECTIVE COHORT STUDY

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Ethiopia

Oral or Poster

Obstructive jaundice is the most common symptom of malignant diseases of the extrahepatic biliary system and necessitates either non-operative or operative biliary bypass. Because of percutaneous and endoscopic approaches, the use of palliative surgical procedures has decreased in recent years. However, in resource-limited situations, open biliary bypasses remain a viable option. This study aimed to identify factors associated with adverse perioperative outcomes following open biliary bypass.

From June 2022 to May 2023, 69 patients underwent open biliary bypass for malignant biliary obstruction. Postoperative morbidity and mortality within 30 days of surgery were assessed. A Kaplan-Meier was used for categorical variables, and a log-rank test was used to determine the statistically significant difference between variables. A Cox regression analysis was conducted to identify factors associated with time to develop complications.

The hazard of developing complications among those with preoperative cholangitis was 2.49 times higher than those without preoperative cholangitis (HR 2.49, 95% CI [1.06, 5.84]). For every hour increment in the length of surgery, the hazard of getting complications increased by 2.47 times (HR 2.47, 95% CI [1.28, 4.77]). As serum bilirubin increased by 1mg/dl, the hazard of developing complications increased by 14% (HR 1.14, 95% CI [1.03, 1.17]).

Patients who had long operation times, preoperative cholangitis, and elevated total bilirubin levels are at increased risk for poor perioperative outcomes. Clinicians may use these results to optimize these patients to decrease their elevated risk of serious morbidity and mortality.