title: Delayed Gastric Emptying After Pancreaticoduodenectomy: an Analysis of Risk Factors and Cost.
abstract: BACKGROUND
  Delayed gastric emptying (DGE) is a common complication after pancreaticoduodenectomy (PD), yet it remains incompletely understood. The International Study Group of Pancreatic Surgery (ISGPS) in 2007 defined a three-tiered grading system to standardize studies of DGE.
  
  
  METHODS
  In this study, 721 patients undergoing PD between 2006 and 2012 were retrospectively categorized by the ISGPS DGE criteria, as well as a modified grading system (termed primary DGE) if, on retrospective review, DGE was not believed to be a sequela of a separate complication. Predictive factors and associated outcomes were determined.
  
  
  RESULTS
  ISGPS-defined DGE occurred in 140 (19.4%) patients. In a multivariate analysis, predictors of ISGPS-defined DGE included abdominal infection (odds ratio (OR) 5.5, p < 0.001), male gender (OR 1.92, p = 0.007), smoking history (OR 1.75 p = 0.033), and periampullary adenocarcinoma (OR 1.66, p = 0.041). Primary DGE occurred in 12.2% of patients. Predictors included abdominal infection (OR 3.15, p < 0.001) and smoking history (OR 2.04, p = 0.008). Median hospital charges increased over $10,000 with each severity grade of DGE (p < 0.001).
  
  
  CONCLUSIONS
  DGE is common after PD and contributes substantially to cost. DGE is frequently a secondary complication of abdominal infection, and interventions that limit such complications may be the most effective strategy toward preventing DGE.
authors.affiliation: Department of Surgery, The Jefferson Pancreas, Biliary, and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Eisenberg
authors.forename: Ernest L
authors.initials: EL
authors.lastname: Rosato
authors.forename: Harish
authors.initials: H
authors.lastname: Lavu
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Yeo
authors.forename: Jordan M
authors.initials: JM
authors.lastname: Winter
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004067:Digestive System Neoplasms / Q000601:surgery*; D005260:Female; D005746:Gastric Emptying; D006801:Humans; D059413:Intraabdominal Infections / Q000150:complications; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking; D013272:Stomach Diseases / Q000175:diagnosis* / Q000191:economics / Q000503:physiopathology*; D013997:Time Factors; D055815:Young Adult