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The perioperative factors affecting mortality and morbidity in patients undergoing biliary surgeries.

BACKGROUND

Biliary surgeries especially in patients with perioperative jaundice are challenging [1] even though laparoscopic and endoscopic techniques have improved the visualisation of operative field. The modern investigations delineate the anatomy, but morbidity and mortality remains high for biliary surgeries.

This can be prevented to an extent by proper perioperative care and assessment. With proper assessment, some, if not all, of these factors can be controlled preoperatively leading to a better outcome of surgery. This study tries to identify certain preoperative risk factors in jaundiced patients who undergo surgery of the biliary tract and correlate them with postoperative mortality and morbidity. Around 18 preoperative factors are used to assess the outcome of biliary surgeries.

MATERIALS AND METHODS

Data Collection

This is a study of 150 Cases of biliary tract disease diagnosed and treated at KAPV Government Medical College and Mahatma Gandhi Memorial Government Hospital, Tiruchirapalli, Tamilnadu for a period of 2 years.

RESULTS

Research Design

Hospital based cross sectional study.

Inclusion Criteria

Only those who consent to enrol in the study and those undergoing surgery in the biliary tract only, with a biliary drainage procedure.

Exclusion Criteria

Those who do not give consent and those undergoing surgery of biliary tract along with some other surgeries in the abdomen and those undergoing emergency biliary surgery following trauma. Cases with surgeries on biliary tract without a biliary drainage procedure are also excluded.

Method of Data Collection

Hospital records, interviewing the patients and also from investigation reports and lab results.

Statistical Analysis

Prevalence of each risk factor is expressed in terms of frequencies and percentages. Morbidity and mortality also is expressed in a similar manner. The relation between the primary and secondary objectives was studied using the Chi square test, with the help of Software, SPSS. Binary logistic regression was done to find out factors independently predicting the occurrence of morbidity and mortality.

Aims and Objectives

1. Primary Objective- To find out the prevalence of preoperative risk factors present in patients undergoing biliary tract surgeries.

2. Secondary Objective- To find out the morbidity and mortality among patients undergoing biliary tract surgeries within a followup period of 30 days.

RESULTS

Interpretation

Out of the 150 patients studied, 80 (53.3%) were male and 70 (46.7.1%) were female. 42.81% had benign and 57.19% had malignant cause for obstruction. 32.5% had fever in the preoperative period and 63.1% had jaundice for more than 3 weeks. 40% of patients had a serum bilirubin level more than 10 mg/dL. 15% had systemic hypertension and 30% had diabetes mellitus. 31.24% of patients underwent preoperative biliary drainage by endoscopic routes. 20.2% had a haematocrit less than 30 and 30.2% had a total leucocyte count more than 10,000/[mm.sup.3]. PT-INR value was more than 1.5 in 10.1%. 11% of patients had a blood urea value more than 40 mg/dL and 5.2% had serum creatinine levels higher than 1.5 mg/dL in the preoperative period. AST and ALT elevation above 100 IU/L were observed in 34% and 29.8% of patients respectively. Alkaline phosphatase levels in serum was elevated above 150 IU/L in 80.2% of patients. 33.5% had a BMI less than 17.5 and 14.9% had ascites. 66% of the surgeries took more than three hours to complete. 13% of the patients had postoperative renal failure. Surgical site infection occurred in 34% of patients. 9.6% had gastrointestinal haemorrhage and 7.2% patients developed intra-abdominal abscess. Infection and sepsis was observed in 20% and pulmonary complication in 25.6%. The overall mortality observed is 9.4%.

Frequency and percentage of patients with diabetes mellitus

Type of Surgery

* Drainage procedure alone- 19%.

* Drainage procedure plus biliary enteric anastomosis41%.

* Drainage plus biliary enteric anastomosis plus liver/biliary resection.

* 40% Morbidity.

Bivariate Analysis

Bivariate analysis was done using Chi squared test to establish the effect (if any) of each risk factor on the outcome variables (morbidity and mortality). The statistical significance of the effect of each factor on outcome can be determined by the Pearson Chi square value. A value less than 0.05 is taken as statistically significant. Contingency tables were generated between each of the risk factors and outcome variables (morbidity and mortality). Pearson Chi squared test and Fisher's exact test (where numbers were small) were done. Odds ratio was also calculated. The following tables show the statistical significance of association between morbidity/mortality and the risk factors evaluated.

From Tables 4-9, according to Pearson Chi-square test, the factors significantly affecting the development of renal failure are more than 10 mg/dL bilirubin level, duration of jaundice more than 3 weeks, malignant disease, diabetes mellitus, operation time more than 3 hours, high total leucocyte count, low haematocrit, elevated creatinine and a high alkaline phosphatase level. Binary logistic regression was done to identify risk factors which are independent predictors of post-operative renal failure.

Pre-operative bilirubin levels more than 10 mg/dL was the only significant variable which independently predicted renal failure. None of the other factors had any significant independent association

From the results of Pearson Chi-squared test, it can be interpreted that the factors significantly affecting the occurrence of surgical site infections are alkaline phosphate levels above 150 IU/L, body mass index less than 17.5, WBC count more than 10000, presence of ascites, serum urea levels higher than 40 mg/dL, presence of diabetes mellitus, amount of bilirubin more than 10 mg/dL and ALT levels more than 100 IU/L.

Binary logistic regression identified a single significant independent predictor of surgical site infection, preoperative bilirubin levels more than 10 mg/dL. None of the other factors were independently associated with the development of surgical site infection.

Factors Affecting Gastrointestinal Haemorrhage, Results of Chi-Squared Test

From the P - values in Chi-squared test, it can be interpreted that the factors associated with the occurrence of gastrointestinal haemorrhage are total leucocyte count more than 10,000/[mm.sup.3], PT-INR more than 1.5, amount of bilirubin more than 10 mg/dL and alkaline phosphatase level more than 150 IU.

Binary logistic regression was done and found that total leucocyte count above 10,000/[mm.sup.3] and PT-INR above 1.5 are independently associated with the occurrence of gastrointestinal bleeding.

From Tables 22 - 27, after performing Chi-squared test, none of the tested factors show any statistically significant association with the occurrence of intra-abdominal abscess.

Factors Affecting Infection and Sepsis, Results of Chi-Squared Test

From Tables 28-32, according to Pearson Chi-squared test, the factors significantly affecting infective and septic complications are total leucocyte count more than 10000, amount of bilirubin more than 10 mg/dL, body mass index less than 17.5, an operation time more than 3 hours, presence of diabetes mellitus, alkaline phosphatase levels above 150 IU, the type of surgical procedure, fever, serum creatinine levels higher than 1.5, malignant cause for biliary obstruction, duration of jaundice more than 3 weeks. After applying binary logistic regression, the factors found to have independent association with infective and septic complications are duration of jaundice more than three weeks, diabetes mellitus, elevated serum creatinine value and the type of surgery done.

RESULTS

In our study, it has been interpreted that

1. Renal failure is more common in patients with malignancy, diabetes mellitus, low haematocrit, total leucocyte count more than 10000, urea >40, ALP >150.

2. Surgical site infection varies with type of surgery and its duration, bilirubin >10 mg%, urea >40 mg%.

3. Sepsis is more commonly seen in patients with malignant condition, patients with BMI less than 17.5, systemic hypertension, diabetes mellitus, fever, total leucocyte count >10000, urea >40 mg%, alkaline phosphatase >150, with ascites, duration of surgery >3 hrs.

DISCUSSION

Prevalence of each risk factor in the study population is expressed and compared with morbidity and mortality in postoperative period. Most of the risk factors are non-modifiable. Certain modifiable factors include a low haematocrit and BMI. These can be addressed by giving extra care to the nutrition of the patient in the preoperative period. Even total parenteral nutrition is justified in selected patients, since the concerns regarding mucosal atrophy and bacterial translocation limited its use. Nutritional problems can also be due to anomalous hepatic and biliary dysfunction which should also be cared off.

Renal failure remains an important postoperative problem in surgeries for biliary obstruction. [2] The percentage of renal failure in current study is 10%. Single most important factor with independent effect on renal failure identified in present study is a preoperative bilirubin level more than 10 mg/dL [3]. Thus, preoperative biliary drainage may play a significant role in decreasing postoperative renal failure as well. [4] But here again, careful patient selection is warranted.

The incidence of surgical site in percentage in the present study is 30. The single most important independent predictor of surgical site infection identified by regression analysis is an amount of bilirubin more than 10 mg/dL. [5] Measures to reduce pre-operative bilirubin values to less than ten percentage should be taken if this potentially serious complication is to be prevented.

Incidence of infection and sepsis in present study is 20%, which is in excess compared to other surgeries and in literature, probably because of the small sample size and in part because of the late presentation of most of our patients to the surgeon. Independent predictors of sepsis identified in regression analysis are duration of jaundice more than three weeks, diabetes mellitus, elevated serum creatinine value and the type of surgery done. [6] Sepsis is the only complication in the present study which has association with the type of surgery.

Prevention of this complication includes prompt biliary drainage in selected patients, control of infections and reduction of hepatic ascites by medical management. Mortality rates varying between 8 and 33% had been reported in literature for surgeries to relieve biliary obstruction. Mortality rate observed in the present study is 9.4% which is comparable to older studies. (1) The malignant causes for biliary obstruction, [7] duration of jaundice more than 3 weeks, [8] amount of bilirubin more than 10 mg/dL [9] presence of diabetes mellitus, total leucocyte count more than 10000, serum creatinine levels higher than 1.5, alkaline phosphate levels above 150 IU/L, body mass index less than 17.5 and an operation time more than 3 hours were all found significant in the bivariate analysis.

But while taking the inter-relationship of these factors into account and after performing a regression analysis, it was found that operating time more than 3 hours, elevated total leucocyte count (more than 10,000/mm3) and a bilirubin level more than 10 mg/dL are independently associated with a high mortality rate.

Summary

In this hospital based cross sectional study, conducted in a tertiary care centre, over a period of 24 months, a total of 150 cases of biliary obstructions were studied. All of them underwent surgery to relieve biliary obstruction. The prevalence of 21 different risk factors in this study population was identified. The relationship between these 21 clinical, laboratory, and operative parameters to postoperative morbidity and mortality was analysed. Prevalence of the proposed risk factors are expressed in percentage. The relationship of preoperative factors and postoperative complications were analysed using Chi-squared tests and Fisher's exact test where numbers were small. Binary logistic regression was used to test the relationship between the preoperative factors and postoperative mortality. The overall mortality observed is 9.4%. After performing Chi-square tests and binary logistic regression, the factors with independent effect on morbidity and mortality were listed. An operating time more than 3 hours, [10] elevated total leucocyte count (more than 10,000/[mm.sup.3])n and a bilirubin level more than 10 mg/dL are independently associated with a high mortality rate. Preoperative bilirubin levels of more than 10 mg/dL is independently associated with higher incidence of postoperative renal failure and surgical site infection.

Duration of jaundice more than three weeks, [12] diabetes mellitus, [13] elevated serum creatinine value above 1.5 mg% [14] and the type of surgery done are the independent factors affecting post-operative sepsis. None of the tested variables showed any statistically significant relation with the development of intra-abdominal abscess formation.

CONCLUSION

The morbidity and mortality of the patients undergoing biliary surgeries especially jaundiced patients can be controlled by preoperative biliary drainage, correcting renal parameters and choosing correct mode of surgical technique. Even then biliary tract surgeries are challenging to surgeons.

REFERENCES

[1] Cherqui D, Benoist S, Malassagne B, et al. Major liver resection for carcinoma in jaundiced patients without preoperative biliary drainage. Arch Surg 2000; 135(3):302-8.

[2] Dixon JM, Armstrong CP, Duffy SW, et al. Factors affecting morbidity and mortality after surgery for obstructive jaundice: a review of 373 patients. Gut 1983; 24(9):845-52.

[3] de Mendonqa A, Vincent JL, Suter PM, et al. Acute renal failure in the ICU: risk factors and outcome evaluated by the SOFA score. Intensive Care Medicine 2000; 26(7):915-21.

[4] Poon RT, Fan ST, Lo CM, et al. Improving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary diseases: analysis of 1222 consecutive patients from a prospective database. Ann Surg 2004; 240(4):698-708.

[5] Collins LA, Samore MH, Roberts MS, et al. Risk factors for invasive fungal infections complicating orthotopic liver transplantation. J Infect Dis1994; 170(3):644-52.

[6] Perez AJA, Gonzalez JJ, Baldonedo RF, et al. Clinical course, treatment and multivariate analysis of risk factors for pyogenic liver abscess. Am J Surg 2001; 181(2):177-86.

[7] Schmassmann A, von Gunten E, Knuchel J, et al. Wallstents versus plastic stents in malignant biliary obstruction: effects of stent patency of the first and second stent on patient compliance and survival. Am J Gastroenterol 1996; 91(4):654-9.

[8] Burris HA, Moore MJ, Andersen J, et al. Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J clin oncol 1997; 15(6):2403-13.

[9] Goris RJ, te Boekhorst TP, Nuytinck JK, et al. Multiple organ failure: generalized autodestructive inflammation? Arch Surg 1985; 120(10):1109-15.

[10] Trede MI, Schwall G, Saeger HD. Survival after pancreaticoduodenectomy. 118 consecutive resections without an operative mortality. Ann Surg 1990; 211(4):447-58.

[11] Pitt HA, Cameron JL, Postier RG, et al. Factors affecting mortality in biliary tract surgery. Am J Surg 1981; 141(1):66-72.

[12] Maisels MJ, Kring E. Length of stay, jaundice and hospital readmission. Pediatrics 1998; 101(6):995-8.

[13] Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. AnnSurg 1995; 222(3):339-52.

[14] Gallardo LM, Gutierrez HME, Perez SG, et al. Risk factors for renal dysfunction in the postoperative course of liver transplant. Liver transpl 2004; 10(11):1379-85.

S. Senthilvel (1), S. S. Abhinand (2), Thangamani (3)

(1) Associate Professor, Department of General Surgery, Pudukkottai Medical College, Tamilnadu.

(2) Postgraduate Student, Department of General Surgery, KAPV Government Medical College, Trichy.

(3) Postgraduate Student, Department of General Surgery, KAPV Government Medical College, Trichy.

Financial or Other, Competing Interest: None.

Submission 30-01-2016, Peer Review 16-03-2017,

Acceptance 22-03-2017, Published 03-04-2017.

Corresponding Author: Dr. S. S. Abhinand, JR Surgery, KAPV Government Medical College, Junior Resident Quarters L Block Room No 22, Trichy- 620001.

E-mail: abhinandss@gmail.com

DOI: 10.14260/jemds/2017/482

Caption: Figure 2

Caption: Figure 3

Caption: Figure 4
Table 1

Following Factors are Studied

             Risk                Normal/              At Risk
           Factors               No Risk

1            AGE                < 60 years           >60 years
2        Disease type             Benign             Malignant
3           Fever                 Absent              Present
4    Duration of Jaundice       < 3 weeks             >3 weeks
5    Amount of Bilirubin        <10 mg/dL            >10 mg/dL
6        Hypertension             Absent              Present
7     Diabetes mellitus           Absent              Present
     Preoperative biliary        Not done               Done
           drainage
9        Haematocrit               >30%                 <30%
10           TLC            <10,000/[mm.sup.3]   >10,000/[mm.sup.3]
11          PT-INR                 <1.5                 >1.5
12         S. Urea              <40 mg/dL            >40 mg/dL
13      S. Creatinine           <1.5 mg/dL           >1.5 mg/dL
14           AST                 <100IU/L             >100IU/L
15           ALT                 <100IU/L             >100IU/L
16           ALP                 <100IU/L             >150IU/L
17    HBV/HCV infection           Absent              Present
18         Ascites                Absent              Present
19           BMI                 17.5-24               <17.5
20      Operation time           <3 hours             >3 hours
21     Type of surgery                Type 1 Type 2 Type 3

Table 2: Frequency and Percentage of Patients with Systemic
Hypertension

          Patients' Frequency   % Percent   Cumulative Percentage

Absent            127             85.0              85.0
Present           23              15.0              100.0
Total             150             100.0

Table 3. Diabetes

          Frequency   % Percent   Cumulative Percentage

Absent       105        70.0              70.0
Present      45         30.0               30
Total        150        100.0             100.0

Table 4: Factors Affecting Renal Failure, Results of Chi-squared
test

Morbidity

       Risk      Pearson Chi   df     P     Significance
     Factors       Square           Value

     Age more
1    than 60        0.527      1    0.487
      years
2   Malignant       6.957      1    0.005    Significant
     disease
3    Type of        1.906      2    0.312
     surgery
    Body mass
4   index less      0.701      1    0.297
    than 17.5

Table 5: Factors Affecting Renal Failure, Results of Chi-
squared test

       Risk       Pearson    df      P
      Factors       Chi            value   Significance
                  Square

    Presence of
1    systemic      0.077     1     0.678
    hypertension
    Presence of
2    diabetes      5.176     1     0.024   Significant
     mellitus
3   Presence of    0.019     1     0.763
       fever

Table 6: Factors Affecting Renal Failure, Results of Chi-squared
test

        Risk        Pearson    df      P     Significance
       Factors        Chi            value
                    Square

1    Haematocrit     4.278     1     0.018   Significant
    less than 30%
2    T L C more      4.780     1     0.022   Significant
     than 10,000
3    PT-INR more     0.074     1     0.692
      than 1.5
4   S. Creatinine    2.943     1     0.069
    more than 1.5
5   S. Urea more     4.241     1     0.023   Significant
    than 40 mg%

Table 7: Factors Affecting Renal Failure, Results of Chi-
squared test

        Risk        Pearson   df     P     Significance
       Factors        Chi          value
                    Square

1   AST more than    1.071    1    0.301
       100IU/L
2   ALT more than    0.122    1    0.727
       100IU/L
3   ALP more than    4.583    1    0.032   Significant
       150IU/L

Table 8: Factors Affecting Renal Failure, Results of Chi-squared
test

         Risk        Pearson    df      P
       Factors         Chi            value   Significance
                     Square

     Presence of
1      HBV/HCV        0.436     1     0.502
      infection
     Presence of      2.735     1     0.077
2      ascites
    Operation time
3    more than 3      5.108     1     0.014   Significant
        hours

Table 9: Factors Affecting Surgical Site Infection, Results of Chi-
squared test

        Risk        Pearson   Df     P     Significance
       Factors        Chi          value
                    square

1     Age more       0.281    1    0.543
    than 60 years
2     Malignant      0.207    1    0.634
       disease
3      Type of       6.241    1    0.014   Significant
       surgery
      Body mass
4    index less      0.429    2    0.715
      than 17.5

Table 10: Factors Affecting Surgical Site Infection, Results
of Chi-squared test

                        Pearson   Df     P     Significance
      Risk factors        Chi          value
                        square

       Presence of
1       systemic         1.730    1    0.154
      hypertension
2      Presence of       3.546    1    0.029   Significant
    diabetes mellitus
3   Presence of fever    0.394    1    0.328

Table 11: Factors Affecting Surgical Site Infection, Results of Chi-
squared test

      Risk Factors     Pearson   df     P     Significance
                         Chi          value
                       square

      Duration of
        Jaundice        2.920    1    0.140
      more than 3
         months
       Amount of
2    Bilirubin more     3.872    1    0.039   Significant
     than 10 mg/dL
      Preoperative
3   biliary drainage    0.204    1    0.577
          done

Table 12: Factors Affecting Surgical Site Infection, Results of Chi-
squared test

        Risk         Pearson     Df     P     Significance
       Factors      Chi Square        Value

1    Haematocrit      1.993      1    0.174
    less than 30%
2    T L C more       10.847     1    0.001   Significant
     than 10,000
3    PT-INR more      0.037      1    0.895
      than 1.5
4   S. Urea more      3.959      1    0.036   Significant
     than 40 mg%
5   S. Creatinine     1.974      1    0.181
    more than 1.5

Table 13: Factors Affecting Surgical Site Infection, Results
of Chi-squared test

      Risk     Pearson   df     P     Significance
    Factors      Chi          value
               square

    AST more
1   than 100    2.769    1    0.076
      IU/L
    ALT more
2   than 100    3.247    1    0.049   Significant
      IU/L
    ALP more
3   than 150    6.845    1    0.008   Significant
      IU/L

Table 14: Factors Affecting Surgical Site Infection, Results
of Chi-squared test

       Risk       Pearson    df      P     Significance
      Factors       Chi            value
                  Square

    Presence of
1     HBV/HCV      0.482     1     0.480
     infection
2   Presence of    5.259     1     0.022   Significant
      ascites
     Operation
3    time more     1.270     1     0.260
    than 3 hours

Table 15: Factors Affecting Gastrointestinal Haemorrhage Results of
Chi-squared test

       Risk      Pearson   df     P
     Factors       Chi          value   Significance
                 square

     Age more
1    than 60      1.081    1    0.108
      years
2   Malignant     1.002    1    0.292
     disease
3    Type of      2.206    2    0.332
     surgery
    Body mass
4   index less    0.781    1    0.362
    than 17.5

Table 16: Factors Affecting Gastrointestinal Haemorrhage,
Results of Chi-squared test

      Risk Factors      Pearson   df     P     Significance
                          Chi          value
                        square

       Presence of
1       systemic         0.320    1    0.491
      hypertension
2      Presence of       0.049    1    0.781
    diabetes mellitus
3   Presence of fever   1.065     1    0.167

Table 17: Factors Affecting Gastrointestinal Haemorrhage, Results of
Chi-squared test

          Risk         Pearson          P
        Factors          Chi     df   Value   Significance
                       Square

      Duration of
1    Jaundice more      0.681    1    0.398
     than 3 months
       Amount of
2    Bilirubin more     5.201    1    0.014   Significant
     than 10 mg/dL
      Preoperative
3   biliary drainage    1.23     1    0.247
          done

Table 18: Factors Affecting Gastrointestinal Haemorrhage, Results of
Chi-squared test

         Risk        Pearson   df     P     Significance
       Factors         Chi          value
                     Square

1    Haematocrit      0.587    1    0.391
    less than 30 %
2     T L C more     12.679    1    0.001   Significant
     than 10,000
3    PT-INR more     14.632    1    0.001   Significant
       than 1.5
4   S. Creatinine     0.129    1    0.472
    more than 1.5
5    S. Urea more     0.385    1    0.535
     than 40 mg%

Table 19: Factors Affecting Gastrointestinal Haemorrhage, Results of
Chi-squared test

      Risk     Pearson   df     P     Significance
    Factors      Chi          Value
               Square

    AST more
1   than 100    0.947    1    0.330
      IU/L
    ALT more
2   than 100    3.345    1    0.067
      IU/L
    ALP more
3   than 150    3.966    1    0.046   Significant
      IU/L

Table 20: Factors Affecting Gastrointestinal Haemorrhage, Results of
Chi-squared test

         Risk        Pearson    df      P     Significance
       Factors         Chi            Value
                     Square

     Presence of
1      HBV/HCV        0.114     1     0.736
      infection
2    Presence of      0.005     1     0.942
       ascites
    Operation time
3    more than 3      1.256     1     0.262
        hours

Table 21: Factors Affecting the Development of Intra-Abdominal
Abscess, Results of Chi-squared test

       Risk      Pearson   df     P     Significance
     Factors       Chi          value
                 Square

     Age more
1    than 60      0.327    1    0.519
      years
2   Malignant     0.026    1    0.851
     disease
3    Type of      0.968    2    0.436
     surgery
    Body mass
4   index less    0.144    1    0.544
    than 17.5

Table 22: Factors Affecting the Development of Intra-Abdominal
Abscess, Results of Chi-squared test

        Risk       Pearson   df   P value   Significance
      Factors        Chi
                   Square

    Presence of
1     systemic      0.094    1     0.759
    hypertension
    Presence of
2     diabetes      1.343    1     0.246
      mellitus
3   Presence of     0.500    1     0.986
       fever

Table 23: Factors Affecting the Development of Intra-Abdominal
Abscess, Results of Chi-squared test

          Risk          Pearson     df     P     Significance
        Factors        Chi square        value

      Duration of
1    Jaundice more       0.279      1    0.597
     than 3 months
       Amount of
2    Bilirubin more      0.146      1    0.702
     than 10 mg/dL
      Preoperative
3   biliary drainage     0.278      1    0.598
          done

Table 24: Factors affecting the development of intra-abdominal
abscess, results of Chi-squared test

        Risk        Pearson    df      P     Significance
       Factors        Chi            value
                    Square

1    Haematocrit     1.451     1     0.228
    less than 30%
2    T L C more      1.796     1     0.180
     than 10,000
3    PT-INR more     1.045     1     0.307
      than 1.5
4   S. Creatinine    0.043     1     0.836
    more than 1.5
5   S. Urea more     2.870     1     0.090
     than 40 mg%

Table 25: Factors Affecting the Development of Intra-Abdominal
Abscess, Results of Chi-squared test

      Risk     Pearson   df     P     Significance
    Factors      Chi          value
               Square

    AST more
1     than      0.786    1    0.375
    100IU/L
    ALT more
2     than      2.299    1    0.135
    100IU/L
    ALP more
3     than      0.025    1    0.874
    150 IU/L

Table 26: Factors Affecting the Development of Intra-Abdominal
Abscess, Results of Chi-squared test

       Risk       Pearson   df     P     Significance
      Factors       Chi          value
                  Square

    Presence of
1     HBV/HCV      1.600    1    0.206
     infection
2   Presence of    1.592    1    0.207
      ascites
     Operation
3    time more     0.797    1    0.372
    than 3 hours

Table 27: Factors Affecting Infection and Sepsis, Results of Chi-
squared test

        Risk        Pearson   df     P     Significance
       Factors        Chi          value
                    Square

1     Age more       0.029    1    0.745
    than 60 years
2     Malignant      5.965    1    0.009   Significant
       disease
3      Type of       7.980    2    0.012   Significant
       surgery
      Body mass
4    index less      8.358    1    0.001   Significant
      than 17.5

Table 28: Factors Affecting Infection and Sepsis, Results of Chi-
squared test

        Risk       Pearson   df     P     Significance
      Factors        Chi          value
                   Square

    Presence of
1     systemic      4.404    1    0.019   Significant
    hypertension
    Presence of
2     diabetes     12.325    1    0.001   Significant
      mellitus
3   Presence of     4.098    1    0.021   Significant
       fever

Table 29: Factors Affecting Infection and Sepsis, Results of Chi-
squared test

          Risk         Pearson   df     P     Significance
        Factors          Chi          value
                       Square

      Duration of
1    Jaundice more     13.686    1    0.001   Significant
     than 3 months
       Amount of
2    Bilirubin more     5.257    1    0.011   Significant
     than 10 mg/dL
      Preoperative
3   biliary drainage    2.240    1    0.108
          done

Table 30: Factors Affecting Infection and Sepsis, Results of
Chi-squared test

        Risk        Pearson   df     P     Significance
       Factors        Chi          value
                    Square

1    Haematocrit     3.412    1    0.046
    less than 30%
2    T L C more      5.270    1    0.029   Significant
     than 10,000
3    PT-INR more     0.074    1    0.619
      than 1.5
4   S. Creatinine    3.306    1    0.051
    more than 1.5
5   S. Urea more     5.80     1    0.019   Significant
     than 40 mg%

Table 31: Factors Affecting Infection and Sepsis, Results of
Chi-squared test

         Risk        Pearson   df     P     Significance
       Factors         Chi          Value
                     Square

     Presence of
1      HBV/HCV        0.926    1    0.291
      infection
2    Presence of      6.381    1    0.010   Significant
       ascites
    Operation time
3    more than 3      7.226    1    0.006   Significant
        hours

Figure 1

male     80
female   70

Note: Table made from pie chart.
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Title Annotation:Original Research Article
Author:Senthilvel, S.; Abhinand, S.S.; Thangamani
Publication:Journal of Evolution of Medical and Dental Sciences
Article Type:Report
Date:Apr 3, 2017
Words:4494
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