title: Feeding jejunostomy during Whipple is associated with increased morbidity.
abstract: BACKGROUND
  Placement of a feeding jejunostomy tube (FJ) is often performed during pancreaticoduodenectomy (PD). Few studies, however, have sought to determine whether such placement affects postoperative outcomes after PD.
  
  
  METHODS
  This is a retrospective analysis of the National Surgical Quality Improvement Program (NSQIP) database to determine the 30-d-postoperative mortality rate, major complication rate, and overall complication rate of jejunostomy tube placement at the time of PD. Univariate and multivariate comparison of postoperative outcomes between patients with and without FJ placement during PD was performed on a total of 4930 patients.
  
  
  RESULTS
  Thirty-day-postoperative mortality did not differ between the two groups (4.0% for patients with FJ versus 2.7% without, P = 0.13), whereas overall morbidity (43.3% with FJ versus 34.6% without, P < 0.0001) and serious morbidity (29.5% with FJ versus 22.8% without, P < 0.0001) were significantly higher in patients undergoing FJ placement during PD. The specific complications that occurred more frequently in FJ patients than patients without FJ included deep space surgical site infection, pneumonia, unplanned reintubation, acute renal failure, and sepsis.
  
  
  CONCLUSIONS
  Although FJ placement during PD is considered to be routine at many institutions, our analysis of data from NSQIP suggest that FJ placement may be associated with increased postoperative morbidity.
authors: Department of Surgery, Duke University Medical Center, Durham, North Carolina. Electronic address: padus001@mc.duke.edu.
authors: James C
authors: JC
authors: Padussis
authors: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors: Sabino
authors: S
authors: Zani
authors: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors: Dan G
authors: DG
authors: Blazer
authors: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors: Douglas S
authors: DS
authors: Tyler
authors: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors: Theodore N
authors: TN
authors: Pappas
authors: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors: John E
authors: JE
authors: Scarborough
mesh_terms: D000368:Aged; D004750:Enteral Nutrition / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D005260:Female; D006801:Humans; D007582:Jejunostomy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D015999:Multivariate Analysis; D016577:Pancreaticoduodenectomy / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Feeding jejunostomy; NSQIP; Pancreaticoduodenectomy