Risk Factors for Morbidity and Mortality Following Gastroenterostomy

Background  Morbidity and mortality following traditional surgical treatment of gastric outlet obstruction is high. The aim of this work was to identify risk factors predictive of postoperative complications and mortality following gastroenterostomy. Methods  One-hundred sixty-five consecutive patients subjected to open gastroenterostomy from January 1996 through July 2003 were included. Data on vital signs and operative variables were retrieved from medical records and recorded retrospectively. Risk factors for postoperative complications and mortality within 30 days after operation were analyzed with multiple logistic regression. Results  The 30-day complication and death rates were higher after emergency operations (80% and 60%) than after elective operations (32% and 25%). A multivariate analysis disclosed that hypoalbuminemia (≤32 g/l), comorbidity, high age, and hyponatremia (<135 μmol/l) were significantly associated with postoperative death, whereas hypoalbuminemia, comorbidity, high age, and emergency operation were predictors of postoperative complications. Conclusions  Complications and mortality after gastroenterostomy due to gastric outlet obstruction are associated with modifiable and non-modifiable risk factors. Prior to surgery means should be taken to correct low albumin and sodium levels to prevent complications. In addition, the surgeon should consider alternative treatment modalities including laparoscopic gastroenterostomy, self-expanding metallic stents, or tube gastrostomy to relieve or palliate gastric outlet obstruction.