Preoperative Biliary Drainage Cuts Mortality Risk in High Bilirubin Patients

In patients undergoing pancreaticoduodenectomy with severe hyperbilirubinemia (≥14.6 mg/dl), preoperative biliary drainage significantly reduces 90-day mortality from 13.3% to lower rates seen in other groups (2.9-5.7%). While biliary drainage increases the risk of surgical site infections (21.2-26.4%), it decreases overall morbidity compared to non-drained patients who face higher rates of acute respiratory distress syndrome (6.0%) and reoperations (18.1%). Preoperative bilirubin ≥14.6 mg/dl independently predicts increased morbidity and mortality.