title: Comparison of intraoperative versus delayed enteral feeding tube placement in patients undergoing a Whipple procedure.
abstract: BACKGROUND
  The intraoperative placement of an enteral feeding tube (FT) during pancreaticoduodenectomy (PD) is based on the surgeon's perception of need for postoperative nutrition. Published preoperative risk factors predicting postoperative morbidity may be used to predict FT need and associated intraoperative placement.
  
  
  METHODS
  A retrospective review of patients who underwent PD during 2005-2011 was performed by querying the National Surgical Quality Improvement Program (NSQIP) database with specific procedure codes. Patients were categorized based on how many of 10 possible preoperative risk factors they demonstrated. Groups of patients with scores of ≤ 1 (low) and ≥ 2 (high), respectively, were compared for FT need, length of stay (LoS) and organ space surgical site infections (SSIs).
  
  
  RESULTS
  Of 138 PD patients, 82 did not have an FT placed intraoperatively, and, of those, 16 (19.5%) required delayed FT placement. High-risk patients were more likely to require a delayed FT (29.3%) compared with low-risk patients (9.8%) (P = 0.026). The 16 patients who required a delayed FT had a median LoS of 15.5 days, whereas the 66 patients who did not require an FT had a median LoS of 8 days (P < 0.001).
  
  
  CONCLUSIONS
  In this analysis, subjects considered as high-risk patients were more likely to require an FT than low-risk patients. Assessment of preoperative risk factors may improve decision making for selective intraoperative FT placement.
authors.affiliation: Department of Surgery, University of Utah Health Care, Salt Lake City, UT, USA.
authors.forename: Courtney L
authors.initials: CL
authors.lastname: Scaife
authors.forename: Kelly C
authors.initials: KC
authors.lastname: Hewitt
authors.forename: Mary C
authors.initials: MC
authors.lastname: Mone
authors.forename: Heidi J
authors.initials: HJ
authors.lastname: Hansen
authors.forename: Edward T
authors.initials: ET
authors.lastname: Nelson
authors.forename: Sean J
authors.initials: SJ
authors.lastname: Mulvihill
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004750:Enteral Nutrition / Q000295:instrumentation*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D018579:Patient Selection; D019990:Perioperative Care; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome