Tests and management affecting survival after portacaval and spenorenal shunts.

New data were derived from records of 115 patients undergoing portacaval or spenorenal shunts from 1966 to 1973. The last serum bilirubin level determined before a shunt was the best predictor of operative mortality. The strongest predictor of long term survival was the first serum albumin level measured after admission. Operative mortality was strongly correlated with intraoperative clotting disorders; however, the prothrombin time and the partial thromboplastin time predicated long term survival. Clinical assessment added unique information to conclusion derived from laboratory tests. Results of operation were independent of the skill and experience of the surgeon, except that the best risk patients perhaps may have done better when operated upon by the most experienced surgeons. Once a patient has stabilized after a bleeding episode, he might as well be operated upon at the same admission rather than be discharged to be operated upon at a later arbitrary time.