Feeding Jejunostomy Tube Placement in Patients Undergoing Pancreaticoduodenectomy: An Ongoing Dilemma

Daniel P. Nussbaum, Sabino Zani, Kara Penne, Paul J. Speicher, Sandra S. Stinnett, Bryan M. Clary, Rebekah R. White, Douglas Tyler, Dan G. Blazer

Research output: Contribution to journalArticle

14 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1752-1759
Number of pages8
JournalJournal of Gastrointestinal Surgery
Volume18
Issue number10
DOIs
StatePublished - Oct 1 2014
Externally publishedYes

Fingerprint

Jejunostomy
Pancreaticoduodenectomy
Enteral Nutrition
Morbidity
Catheters
Logistic Models
Hypoalbuminemia
Total Parenteral Nutrition
Reoperation
Malnutrition

Keywords

  • Feeding tube
  • Jejunostomy feeding tube
  • Nutrition
  • Outcomes
  • Pancreaticoduodenectomy
  • Whipple

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Nussbaum, D. P., Zani, S., Penne, K., Speicher, P. J., Stinnett, S. S., Clary, B. M., ... Blazer, D. G. (2014). Feeding Jejunostomy Tube Placement in Patients Undergoing Pancreaticoduodenectomy: An Ongoing Dilemma. Journal of Gastrointestinal Surgery, 18(10), 1752-1759. https://doi.org/10.1007/s11605-014-2581-6

Feeding Jejunostomy Tube Placement in Patients Undergoing Pancreaticoduodenectomy : An Ongoing Dilemma. / Nussbaum, Daniel P.; Zani, Sabino; Penne, Kara; Speicher, Paul J.; Stinnett, Sandra S.; Clary, Bryan M.; White, Rebekah R.; Tyler, Douglas; Blazer, Dan G.

In: Journal of Gastrointestinal Surgery, Vol. 18, No. 10, 01.10.2014, p. 1752-1759.

Research output: Contribution to journalArticle

Nussbaum, DP, Zani, S, Penne, K, Speicher, PJ, Stinnett, SS, Clary, BM, White, RR, Tyler, D & Blazer, DG 2014, 'Feeding Jejunostomy Tube Placement in Patients Undergoing Pancreaticoduodenectomy: An Ongoing Dilemma', Journal of Gastrointestinal Surgery, vol. 18, no. 10, pp. 1752-1759. https://doi.org/10.1007/s11605-014-2581-6
Nussbaum, Daniel P. ; Zani, Sabino ; Penne, Kara ; Speicher, Paul J. ; Stinnett, Sandra S. ; Clary, Bryan M. ; White, Rebekah R. ; Tyler, Douglas ; Blazer, Dan G. / Feeding Jejunostomy Tube Placement in Patients Undergoing Pancreaticoduodenectomy : An Ongoing Dilemma. In: Journal of Gastrointestinal Surgery. 2014 ; Vol. 18, No. 10. pp. 1752-1759.
@article{2a76fde280744170ac0efc836e06385f,
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.",
keywords = "Feeding tube, Jejunostomy feeding tube, Nutrition, Outcomes, Pancreaticoduodenectomy, Whipple",
author = "Nussbaum, {Daniel P.} and Sabino Zani and Kara Penne and Speicher, {Paul J.} and Stinnett, {Sandra S.} and Clary, {Bryan M.} and White, {Rebekah R.} and Douglas Tyler and Blazer, {Dan G.}",
year = "2014",
month = "10",
day = "1",
doi = "10.1007/s11605-014-2581-6",
language = "English (US)",
volume = "18",
pages = "1752--1759",
journal = "Journal of Gastrointestinal Surgery",
issn = "1091-255X",
publisher = "Springer New York",
number = "10",

}

TY - JOUR

T1 - Feeding Jejunostomy Tube Placement in Patients Undergoing Pancreaticoduodenectomy

T2 - An Ongoing Dilemma

AU - Nussbaum, Daniel P.

AU - Zani, Sabino

AU - Penne, Kara

AU - Speicher, Paul J.

AU - Stinnett, Sandra S.

AU - Clary, Bryan M.

AU - White, Rebekah R.

AU - Tyler, Douglas

AU - Blazer, Dan G.

PY - 2014/10/1

Y1 - 2014/10/1

N2 - 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.

AB - 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.

KW - Feeding tube

KW - Jejunostomy feeding tube

KW - Nutrition

KW - Outcomes

KW - Pancreaticoduodenectomy

KW - Whipple

UR - http://www.scopus.com/inward/record.url?scp=84907861256&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84907861256&partnerID=8YFLogxK

U2 - 10.1007/s11605-014-2581-6

DO - 10.1007/s11605-014-2581-6

M3 - Article

C2 - 24961442

AN - SCOPUS:84907861256

VL - 18

SP - 1752

EP - 1759

JO - Journal of Gastrointestinal Surgery

JF - Journal of Gastrointestinal Surgery

SN - 1091-255X

IS - 10

ER -