Fifteen clinical and laboratory parameters in 155 consecutive patients having bile duct surgery over a 3 year period were analyzed in an effort to define the factors associated with a poor outcome and to define the subpopulation of patients at greatest risk. Ten of the 15 parameters evaluated were found to correlate significantly (p < 0.05) with hospital mortality. Five or more risk factors correlated significantly with mortality (p < 0.0001) and with postoperative renal failure, bacteremia and upper gastrointestinal hemorrhage (p < 0.005). This risk-factor analysis has the advantages of providing information rapidly and employing only clinical observations and readily available laboratory tests. Patients with five or more risk factors should be considered for preoperative percutaneous transhepatic decompression.