Peri-operative risk factors for delayed gastric emptying after a pancreaticoduodenectomy.
BACKGROUND
Delayed gastric emptying (DGE) is a frequent cause of morbidity, prolonged hospital stay and readmission after a pancreaticoduodenectomy (PD). We sought to evaluate predictive peri-operative factors for DGE after a PD.


METHODS
Four hundred and sixteen consecutive patients who underwent a PD at our tertiary referral centre were identified. Univariate and multivariate (MV) logistic regression models were used to assess peri-operative factors associated with the development of clinically significant DGE and a post-operative pancreatic fistula (POPF).


RESULTS
DGE occurred in 24% of patients (n = 98) with Grades B and C occurring at 13.5% (n = 55) and 10.5% (n = 43), respectively. Using MV regression, a body mass index (BMI) ≥35 [odds ratio (OR) = 3.19], operating room (OR) length >5.5 h (OR = 2.72) and prophylactic octreotide use (OR = 2.04) were independently associated with an increased risk of DGE. DGE patients had a significantly longer median hospital stay (12 versus 7 days), higher 90-day readmission rates (32% versus 18%) and an increased incidence of a pancreatic fistula (59% versus 27%). When controlling for POPF, only OR length >5.5 h (OR 2.73) remained significantly associated with DGE.


CONCLUSIONS
DGE remains a significant cause of morbidity, increased hospital stay and readmission after PD. Our findings suggest patients with a BMI ≥35 or longer OR times have a higher risk of DGE either independently or through the development of POPF. These patients should be considered for possible enteral feeding tube placement along with limited octreotide use to decrease the potential risk and consequences of DGE.
Division of Surgical Oncology, Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA.
Jamie R
JR
Robinson
Division of Surgical Oncology, Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA.
Paula
P
Marincola
Division of Surgical Oncology, Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA.
Julia
J
Shelton
Division of Surgical Oncology, Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA.
Nipun B
NB
Merchant
Division of Surgical Oncology, Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA.
Kamran
K
Idrees
Division of Surgical Oncology, Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA.
Alexander A
AA
Parikh
D000368:Aged; D015992:Body Mass Index; D016009:Chi-Square Distribution; D005260:Female; D005746:Gastric Emptying; D018589:Gastroparesis / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010185:Pancreatic Fistula / Q000175:diagnosis / Q000209:etiology; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D010359:Patient Readmission; D012189:Retrospective Studies; D012307:Risk Factors; D013270:Stomach / Q000503:physiopathology*; D013714:Tennessee; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome