title: Comprehensive analysis of variables affecting delayed gastric emptying following pancreaticoduodenectomy.
abstract: BACKGROUND
  Delayed gastric emptying (DGE) occurs commonly following pancreaticoduodenectomy (PD), and criteria for its clinical diagnosis have recently been standardized by an international consensus group. We evaluated 24 operative and peri-operative variables to assess which were independent risk factors for DGE development. Secondarily, we also examined DGE incidence over time and evaluated the consensus guidelines' ability to diagnose DGE in patients with complicated post-operative courses.
  
  
  METHODS
  A prospective, single-surgeon database of 235 patients undergoing PD at an academic tertiary center was retrospectively reviewed and DGE was assessed per published guidelines.
  
  
  RESULTS
  DGE occurred in 42 patients overall (17.9 %), with incidence falling from 30.0 to 9.1% during the study period. Post-operative abscess, pancreatic fistula formation, pulmonary comorbidity, and increased intraoperative blood loss were found to be independent risk factors (p<0.05) for DGE on multivariate analysis. Changes in operative technique, such as pylorus preservation, did not associate with DGE. In a separate analysis, when patients with confounding post-operative events such as re-intubation or re-laparotomy were excluded, DGE incidence was 11.9 %.
  
  
  CONCLUSIONS
  Perturbation of the operative bed by a secondary complication seems to be the dominant risk for DGE development. The consensus guidelines for DGE diagnosis, while indispensable, may overestimate DGE incidence.
authors.affiliation: Section of Surgical Oncology, Department of Surgery, Yale University School of Medicine, P.O. Box 208062, New Haven, CT 06520-8062, USA.
authors.forename: John W
authors.initials: JW
authors.lastname: Kunstman
authors.forename: Annabelle L
authors.initials: AL
authors.lastname: Fonseca
authors.forename: Maria M
authors.initials: MM
authors.lastname: Ciarleglio
authors.forename: Xiangyu
authors.initials: X
authors.lastname: Cong
authors.forename: Abby
authors.initials: A
authors.lastname: Hochberg
authors.forename: Ronald R
authors.initials: RR
authors.lastname: Salem
mesh_terms: D000368:Aged; D005260:Female; D005746:Gastric Emptying; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013272:Stomach Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D016896:Treatment Outcome