title: Delayed gastric emptying following pancreaticoduodenectomy: Incidence, risk factors, and healthcare utilization.
abstract: OBJECTIVE
  To characterize incidence and risk factors for delayed gastric emptying (DGE) following pancreaticoduodenectomy and examine its implications on healthcare utilization.
  
  
  METHODS
  A prospectively-maintained database was reviewed. DGE was classified using International Study Group of Pancreatic Surgery criteria. Patients who developed DGE and those who did not were compared.
  
  
  RESULTS
  Two hundred and seventy-six patients underwent pancreaticoduodenectomy (PD) (> 80% pylorus-preserving, antecolic-reconstruction). DGE developed in 49 patients (17.8%): 5.1% grade B, 3.6% grade C. Demographic, clinical, and operative variables were similar between patients with DGE and those without. DGE patients were more likely to present multiple complications (32.6%vs4.4%, ≥ 3 complications,P< 0.001), including postoperative pancreatic fistula (POPF) (42.9%vs18.9%,P= 0.001) and intra-abdominal abscess (IAA) (16.3%vs4.0%,P= 0.012). Patients with DGE had longer hospital stay (median, 12 dvs7 d,P< 0.001) and were more likely to require transitional care upon discharge (24.5%vs6.6%,P< 0.001). On multivariate analysis, predictors for DGE included POPF [OR = 3.39 (1.35-8.52),P= 0.009] and IAA [OR = 1.51 (1.03-2.22),P= 0.035].
  
  
  CONCLUSIONS
  Although DGE occurred in < 20% of patients after PD, it was associated with increased healthcare utilization. Patients with POPF and IAA were at risk for DGE. Anticipating DGE can help individualize care and allocate resources to high-risk patients.
authors.affiliation: Somala Mohammed, George Van Buren II, Amy McElhany, Eric J Silberfein, William E Fisher, Elkins Pancreas Center, Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, United States.
authors.forename: Somala
authors.initials: S
authors.lastname: Mohammed
authors.affiliation: Somala Mohammed, George Van Buren II, Amy McElhany, Eric J Silberfein, William E Fisher, Elkins Pancreas Center, Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, United States.
authors.forename: George
authors.initials: G
authors.lastname: Van Buren Ii
authors.affiliation: Somala Mohammed, George Van Buren II, Amy McElhany, Eric J Silberfein, William E Fisher, Elkins Pancreas Center, Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, United States.
authors.forename: Amy
authors.initials: A
authors.lastname: McElhany
authors.affiliation: Somala Mohammed, George Van Buren II, Amy McElhany, Eric J Silberfein, William E Fisher, Elkins Pancreas Center, Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, United States.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Silberfein
authors.affiliation: Somala Mohammed, George Van Buren II, Amy McElhany, Eric J Silberfein, William E Fisher, Elkins Pancreas Center, Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, United States.
authors.forename: William E
authors.initials: WE
authors.lastname: Fisher
keywords: Delayed gastric emptying; Pancreaticoduodenectomy; Post-operative pancreatic fistula