title: Factors associated with delayed gastric emptying after pancreaticoduodenectomy.
abstract: BACKGROUND
  The factors associated with delayed gastric emptying (DGE) after a pancreaticoduodenectomy (PD) are not definitively known.
  
  
  METHODS
  From November 2011 through to May 2012, data were prospectively collected on 711 patients undergoing a pancreaticoduodenectomy or total pancreatectomy as part of the American College of Surgeons-National Surgical Quality Improvement Program Pancreatectomy Demonstration Project. Bivariate and multivariate models were employed to determine the factors that predicted DGE.
  
  
  RESULTS
  In the 711 patients, the overall rate of DGE was 20.1%. In a bivariate analysis, intra-operative factors such as pylorus-preservation (47.1% versus 43.7%, P = 0.40), intra-operative drain placement (85.5%, versus 85.1%, P = 0.91) and an antecolic compared with a retrocolic gastrojejunostomy (60.1% versus 65.1%, P = 0.26) were not different between the DGE and no DGE groups. Pancreatic fistula formation (31.2% versus 10.1%), post-operative sepsis (21.7% versus 7.0%), organ space surgical site infection (SSI) (23.9% versus 7.9%), need for percutaneous drainage (23.0% versus 10.6%) and reoperation (10.6% versus 3.1%) were higher in patients with DGE (P < 0.0001). In a multivariable model, only pancreatic fistula, post-operative sepsis and reoperation were independently associated with DGE.
  
  
  CONCLUSIONS
  In this multicentre study, only post-operative complications were associated with DGE. Neither pylorus preservation nor route of enteric reconstruction (antecolic versus retrocolic) was associated with delayed gastric emptying.
authors.affiliation: Departments of Surgery, The University of Texas Medical Branch, Galveston, TX, USA; The University of California, San Francisco-East Bay, Oakland, CA, USA.
authors.forename: Abhishek D
authors.initials: AD
authors.lastname: Parmar
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Sheffield
authors.forename: Gabriela M
authors.initials: GM
authors.lastname: Vargas
authors.forename: Henry A
authors.initials: HA
authors.lastname: Pitt
authors.forename: E Molly
authors.initials: EM
authors.lastname: Kilbane
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Hall
authors.forename: Taylor S
authors.initials: TS
authors.lastname: Riall
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D005746:Gastric Emptying; D018589:Gastroparesis / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010185:Pancreatic Fistula / Q000209:etiology; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011446:Prospective Studies; D012086:Reoperation; D012307:Risk Factors; D018805:Sepsis / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States