Factors associated with delayed gastric emptying after pancreaticoduodenectomy

Abhishek D. Parmar, Kristin M. Sheffield, Gabriela M. Vargas, Henry A. Pitt, E. Molly Kilbane, Bruce L. Hall, Taylor S. Riall

    Research output: Contribution to journalArticle

    52 Citations (Scopus)

    Abstract

    Background The factors associated with delayed gastric emptying (DGE) after a pancreaticoduodenectomy (PD) are not definitively known. Methods From November 2011 through to May 2012, data were prospectively collected on 711 patients undergoing a pancreaticoduodenectomy or total pancreatectomy as part of the American College of Surgeons-National Surgical Quality Improvement Program Pancreatectomy Demonstration Project. Bivariate and multivariate models were employed to determine the factors that predicted DGE. Results In the 711 patients, the overall rate of DGE was 20.1%. In a bivariate analysis, intra-operative factors such as pylorus-preservation (47.1% versus 43.7%, P = 0.40), intra-operative drain placement (85.5%, versus 85.1%, P = 0.91) and an antecolic compared with a retrocolic gastrojejunostomy (60.1% versus 65.1%, P = 0.26) were not different between the DGE and no DGE groups. Pancreatic fistula formation (31.2% versus 10.1%), post-operative sepsis (21.7% versus 7.0%), organ space surgical site infection (SSI) (23.9% versus 7.9%), need for percutaneous drainage (23.0% versus 10.6%) and reoperation (10.6% versus 3.1%) were higher in patients with DGE (P < 0.0001). In a multivariable model, only pancreatic fistula, post-operative sepsis and reoperation were independently associated with DGE. Discussion In this multicentre study, only post-operative complications were associated with DGE. Neither pylorus preservation nor route of enteric reconstruction (antecolic versus retrocolic) was associated with delayed gastric emptying.

    Original languageEnglish (US)
    Pages (from-to)763-772
    Number of pages10
    JournalHPB
    Volume15
    Issue number10
    DOIs
    StatePublished - Oct 2013

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    Pancreaticoduodenectomy
    Gastric Emptying
    Pancreatic Fistula
    Pancreatectomy
    Pylorus
    Reoperation
    Sepsis
    Surgical Wound Infection
    Gastric Bypass
    Quality Improvement
    Multicenter Studies
    Drainage

    ASJC Scopus subject areas

    • Gastroenterology
    • Hepatology

    Cite this

    Parmar, A. D., Sheffield, K. M., Vargas, G. M., Pitt, H. A., Kilbane, E. M., Hall, B. L., & Riall, T. S. (2013). Factors associated with delayed gastric emptying after pancreaticoduodenectomy. HPB, 15(10), 763-772. https://doi.org/10.1111/hpb.12129

    Factors associated with delayed gastric emptying after pancreaticoduodenectomy. / Parmar, Abhishek D.; Sheffield, Kristin M.; Vargas, Gabriela M.; Pitt, Henry A.; Kilbane, E. Molly; Hall, Bruce L.; Riall, Taylor S.

    In: HPB, Vol. 15, No. 10, 10.2013, p. 763-772.

    Research output: Contribution to journalArticle

    Parmar, AD, Sheffield, KM, Vargas, GM, Pitt, HA, Kilbane, EM, Hall, BL & Riall, TS 2013, 'Factors associated with delayed gastric emptying after pancreaticoduodenectomy', HPB, vol. 15, no. 10, pp. 763-772. https://doi.org/10.1111/hpb.12129
    Parmar AD, Sheffield KM, Vargas GM, Pitt HA, Kilbane EM, Hall BL et al. Factors associated with delayed gastric emptying after pancreaticoduodenectomy. HPB. 2013 Oct;15(10):763-772. https://doi.org/10.1111/hpb.12129
    Parmar, Abhishek D. ; Sheffield, Kristin M. ; Vargas, Gabriela M. ; Pitt, Henry A. ; Kilbane, E. Molly ; Hall, Bruce L. ; Riall, Taylor S. / Factors associated with delayed gastric emptying after pancreaticoduodenectomy. In: HPB. 2013 ; Vol. 15, No. 10. pp. 763-772.
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    abstract = "Background The factors associated with delayed gastric emptying (DGE) after a pancreaticoduodenectomy (PD) are not definitively known. Methods From November 2011 through to May 2012, data were prospectively collected on 711 patients undergoing a pancreaticoduodenectomy or total pancreatectomy as part of the American College of Surgeons-National Surgical Quality Improvement Program Pancreatectomy Demonstration Project. Bivariate and multivariate models were employed to determine the factors that predicted DGE. Results In the 711 patients, the overall rate of DGE was 20.1{\%}. In a bivariate analysis, intra-operative factors such as pylorus-preservation (47.1{\%} versus 43.7{\%}, P = 0.40), intra-operative drain placement (85.5{\%}, versus 85.1{\%}, P = 0.91) and an antecolic compared with a retrocolic gastrojejunostomy (60.1{\%} versus 65.1{\%}, P = 0.26) were not different between the DGE and no DGE groups. Pancreatic fistula formation (31.2{\%} versus 10.1{\%}), post-operative sepsis (21.7{\%} versus 7.0{\%}), organ space surgical site infection (SSI) (23.9{\%} versus 7.9{\%}), need for percutaneous drainage (23.0{\%} versus 10.6{\%}) and reoperation (10.6{\%} versus 3.1{\%}) were higher in patients with DGE (P < 0.0001). In a multivariable model, only pancreatic fistula, post-operative sepsis and reoperation were independently associated with DGE. Discussion In this multicentre study, only post-operative complications were associated with DGE. Neither pylorus preservation nor route of enteric reconstruction (antecolic versus retrocolic) was associated with delayed gastric emptying.",
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    AU - Kilbane, E. Molly

    AU - Hall, Bruce L.

    AU - Riall, Taylor S.

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    N2 - Background The factors associated with delayed gastric emptying (DGE) after a pancreaticoduodenectomy (PD) are not definitively known. Methods From November 2011 through to May 2012, data were prospectively collected on 711 patients undergoing a pancreaticoduodenectomy or total pancreatectomy as part of the American College of Surgeons-National Surgical Quality Improvement Program Pancreatectomy Demonstration Project. Bivariate and multivariate models were employed to determine the factors that predicted DGE. Results In the 711 patients, the overall rate of DGE was 20.1%. In a bivariate analysis, intra-operative factors such as pylorus-preservation (47.1% versus 43.7%, P = 0.40), intra-operative drain placement (85.5%, versus 85.1%, P = 0.91) and an antecolic compared with a retrocolic gastrojejunostomy (60.1% versus 65.1%, P = 0.26) were not different between the DGE and no DGE groups. Pancreatic fistula formation (31.2% versus 10.1%), post-operative sepsis (21.7% versus 7.0%), organ space surgical site infection (SSI) (23.9% versus 7.9%), need for percutaneous drainage (23.0% versus 10.6%) and reoperation (10.6% versus 3.1%) were higher in patients with DGE (P < 0.0001). In a multivariable model, only pancreatic fistula, post-operative sepsis and reoperation were independently associated with DGE. Discussion In this multicentre study, only post-operative complications were associated with DGE. Neither pylorus preservation nor route of enteric reconstruction (antecolic versus retrocolic) was associated with delayed gastric emptying.

    AB - Background The factors associated with delayed gastric emptying (DGE) after a pancreaticoduodenectomy (PD) are not definitively known. Methods From November 2011 through to May 2012, data were prospectively collected on 711 patients undergoing a pancreaticoduodenectomy or total pancreatectomy as part of the American College of Surgeons-National Surgical Quality Improvement Program Pancreatectomy Demonstration Project. Bivariate and multivariate models were employed to determine the factors that predicted DGE. Results In the 711 patients, the overall rate of DGE was 20.1%. In a bivariate analysis, intra-operative factors such as pylorus-preservation (47.1% versus 43.7%, P = 0.40), intra-operative drain placement (85.5%, versus 85.1%, P = 0.91) and an antecolic compared with a retrocolic gastrojejunostomy (60.1% versus 65.1%, P = 0.26) were not different between the DGE and no DGE groups. Pancreatic fistula formation (31.2% versus 10.1%), post-operative sepsis (21.7% versus 7.0%), organ space surgical site infection (SSI) (23.9% versus 7.9%), need for percutaneous drainage (23.0% versus 10.6%) and reoperation (10.6% versus 3.1%) were higher in patients with DGE (P < 0.0001). In a multivariable model, only pancreatic fistula, post-operative sepsis and reoperation were independently associated with DGE. Discussion In this multicentre study, only post-operative complications were associated with DGE. Neither pylorus preservation nor route of enteric reconstruction (antecolic versus retrocolic) was associated with delayed gastric emptying.

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