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Risk factors for post‐pancreaticoduodenectomy delayed gastric emptying in the absence of pancreatic fistula or intra‐abdominal infection
Author(s) -
Ellis Ryan J.,
Gupta Aakash R.,
Hewitt D. Brock,
Merkow Ryan P.,
Cohen Mark E.,
Ko Clifford Y.,
Bilimoria Karl Y.,
Bentrem David J.,
Yang Anthony D.
Publication year - 2019
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.25398
Subject(s) - medicine , pancreatic fistula , pancreaticoduodenectomy , gastric emptying , odds ratio , incidence (geometry) , gastroenterology , fistula , retrospective cohort study , surgery , pancreas , stomach , physics , optics
Background and Objectives Delayed gastric emptying (DGE) occurs commonly following pancreaticoduodenectomy (PD), but the rate of DGE in the absence of other intra‐abdominal complications is poorly understood. The objectives of this study were to define the incidence of DGE and identify risk factors for DGE in patients without pancreatic fistula or other intra‐abdominal infections. Methods Retrospective cohort study utilizing the American College of Surgeons National Surgical Quality Improvement Program pancreatectomy variables to identify patients with DGE following PD without evidence of fistula or intra‐abdominal infection. Multivariable models were developed to assess preoperative, intraoperative, and technical factors associated with DGE. Results The rate of DGE was 11.7% in 10502 cases without pancreatic fistula or intra‐abdominal infection. Patients were more likely to develop DGE if age ≥75 (odds ratio [OR], 1.22; P = 0.003), male (OR, 1.29; P < 0.001), underwent pylorus‐sparing PD (OR, 1.27; P = 0.004), or had a prolonged operative time (OR, 1.38 if greater than seven vs less than 5 hours; P = 0.005). Factors not associated with DGE included BMI, pathologic indication, and surgical approach. Conclusion The incidence of DGE after PD is notable even in patients without other abdominal complications. Identification of patients at increased risk for DGE may aid patient counseling as well as decisions regarding surgical technique, enteral feeding access, and enhanced‐recovery pathways.