title: Feeding jejunostomy tube placement in patients undergoing pancreaticoduodenectomy: an ongoing dilemma.
abstract: BACKGROUND
  Concomitant placement of feeding jejunostomy tubes (FJT) during pancreaticoduodenectomy is common, yet there are limited data regarding catheter-specific morbidity and associated outcomes. This information is crucial to appropriately select patients for feeding tube placement and to optimize perioperative nutrition strategies.
  
  
  METHODS
  A review of all patients undergoing pancreaticoduodenectomy with FJT placement was completed. Patients were grouped by the occurrence of FJT-related morbidity. Multivariable logistic regression was performed to identify predictors of FJT morbidity; these complications were then further defined. Finally, associated postoperative outcomes were compared between groups.
  
  
  RESULTS
  In total, 126 patients were included, of which 18 (14 %) had complications directly related to their FJT, including pericatheter infection (n = 6), pneumatosis intestinalis (n = 4), severe tube feed intolerance (n = 3), and primary catheter malfunction (n = 7). Following adjustment with logistic regression, preoperative hypoalbuminemia was identified as the only independent predictor of FJT complications (OR 2.23, p = 0.035). Patients with FJT complications were more likely to be initiated on total parenteral nutrition (TPN; 55.6 vs. 7.4 %, p -0.035) and to require TPN at discharge (16.7 vs. 0%, p = 0.003). Correspondingly, these patients resumed an oral diet later (14 vs. 8 days, p = 0.06). Both reoperation (50.0 vs. 6.5%, p < 0.001) and readmission (50.0 vs. 22.4%, p = 0.041) rates were higher among patients with FJT complications.
  
  
  CONCLUSIONS
  FJT-related morbidity is common among patients undergoing pancreaticoduodenectomy and is associated with inferior outcomes and other performance metrics. Preoperative malnutrition appears to predict FJT complications, creating an ongoing dilemma regarding FJT placement. In the future, it will be important to better define criteria for FJT placement during pancreaticoduodenectomy.
authors: Department of Surgery, Duke University Medical Center, Box 3443, Durham, NC, 27710, USA, daniel.nussbaum@duke.edu.
authors: Daniel P
authors: DP
authors: Nussbaum
authors: Sabino
authors: S
authors: Zani
authors: Kara
authors: K
authors: Penne
authors: Paul J
authors: PJ
authors: Speicher
authors: Sandra S
authors: SS
authors: Stinnett
authors: Bryan M
authors: BM
authors: Clary
authors: Rebekah R
authors: RR
authors: White
authors: Douglas S
authors: DS
authors: Tyler
authors: Dan G
authors: DG
authors: Blazer
mesh_terms: D000230:Adenocarcinoma / Q000628:therapy*; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000295:instrumentation*; D007582:Jejunostomy / Q000379:methods*; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009752:Nutritional Status; D010190:Pancreatic Neoplasms / Q000628:therapy*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000628:therapy; D011184:Postoperative Period; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology