Risk factors for post-pancreaticoduodenectomy delayed gastric emptying in the absence of pancreatic fistula or intra-abdominal infection

Ryan J. Ellis, Aakash R. Gupta, D. Brock Hewitt, Ryan P. Merkow, Mark E. Cohen, Clifford Y. Ko, Karl Y. Bilimoria, David J. Bentrem, Anthony D. Yang*

*Corresponding author for this work

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)925-931
Number of pages7
JournalJournal of surgical oncology
Volume119
Issue number7
DOIs
StatePublished - Jun 1 2019

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Intraabdominal Infections
Pancreatic Fistula
Pancreaticoduodenectomy
Gastric Emptying
Odds Ratio
Pancreatectomy
Pylorus
Incidence
Enteral Nutrition
Operative Time
Quality Improvement
Fistula
Counseling
Cohort Studies
Retrospective Studies

Keywords

  • outcomes
  • pancreatic fistula
  • pancreaticoduodenectomy
  • postoperative complications

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

@article{29be8090bd8e4cc39f80b1e2f0a67432,
title = "Risk factors for post-pancreaticoduodenectomy delayed gastric emptying in the absence of pancreatic fistula or intra-abdominal infection",
abstract = "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.",
keywords = "outcomes, pancreatic fistula, pancreaticoduodenectomy, postoperative complications",
author = "Ellis, {Ryan J.} and Gupta, {Aakash R.} and Hewitt, {D. Brock} and Merkow, {Ryan P.} and Cohen, {Mark E.} and Ko, {Clifford Y.} and Bilimoria, {Karl Y.} and Bentrem, {David J.} and Yang, {Anthony D.}",
year = "2019",
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Risk factors for post-pancreaticoduodenectomy delayed gastric emptying in the absence of pancreatic fistula or intra-abdominal infection. / 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.

In: Journal of surgical oncology, Vol. 119, No. 7, 01.06.2019, p. 925-931.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Risk factors for post-pancreaticoduodenectomy delayed gastric emptying in the absence of pancreatic fistula or intra-abdominal infection

AU - Ellis, Ryan J.

AU - Gupta, Aakash R.

AU - Hewitt, D. Brock

AU - Merkow, Ryan P.

AU - Cohen, Mark E.

AU - Ko, Clifford Y.

AU - Bilimoria, Karl Y.

AU - Bentrem, David J.

AU - Yang, Anthony D.

PY - 2019/6/1

Y1 - 2019/6/1

N2 - 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.

AB - 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.

KW - outcomes

KW - pancreatic fistula

KW - pancreaticoduodenectomy

KW - postoperative complications

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