Abstract
BACKGROUND: Percutaneous transhepatic biliary drainage (PTBD) is widely used in malignant obstructive jaundice (MOJ), but most series report aggregate complication rates without stratification by tumor type. This limits individualized risk counseling and hampers benchmarking across centers. OBJECTIVE: To evaluate short-term outcomes of PTBD in a large single-center cohort, with a focus on tumor-specific complication patterns using patient-level attribution and robust statistical methods. METHODS: We retrospectively analyzed 453 patients with MOJ undergoing PTBD (2017-2022). Complications within 30 days were recorded at the patient level, with downstream sequelae attributed to the index event. Exact tests and Firth penalized logistic regression were applied to mitigate sparse-data bias. Survival status was documented through 90 days. RESULTS: Technical success was 100 %, and mean bilirubin declined significantly within 48 h. Twenty-two complications occurred in 21 patients (4.6 %), lower than most published series. Catheter displacement (1.5 %) was the most frequent event, while severe bleeding (0.2 %) and biliary peritonitis (0.6 %) were rare and managed without surgery. No cholangitis was observed. Complications were most frequent in cholangiocarcinoma and pancreatic cancer, although differences across tumor types were not statistically significant. Follow-up was complete; no deaths occurred within 90 days, yielding 30-day and 90-day survival rates of 100 %. CONCLUSIONS: PTBD is highly effective and safe in MOJ, with lower complication rates than many prior reports. Tumor-specific analysis revealed variation in complication subtypes but no significant differences in overall incidence. The rigorous methodology and complete follow-up provide a robust framework for individualized risk profiling and multicenter benchmarking.