Peri-operative risk factors for delayed gastric emptying after a pancreaticoduodenectomy

Jamie R. Robinson, Paula Marincola, Julia Shelton, Nipun Merchant, Kamran Idrees, Alexander A. Parikh

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)495-501
Number of pages7
JournalHPB
Volume17
Issue number6
DOIs
StatePublished - Jun 1 2015
Externally publishedYes

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Pancreaticoduodenectomy
Gastric Emptying
Pancreatic Fistula
Odds Ratio
Patient Readmission
Length of Stay
Octreotide
Body Mass Index
Logistic Models
Morbidity
Enteral Nutrition
Operating Rooms
Tertiary Care Centers

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Robinson, J. R., Marincola, P., Shelton, J., Merchant, N., Idrees, K., & Parikh, A. A. (2015). Peri-operative risk factors for delayed gastric emptying after a pancreaticoduodenectomy. HPB, 17(6), 495-501. https://doi.org/10.1111/hpb.12385

Peri-operative risk factors for delayed gastric emptying after a pancreaticoduodenectomy. / Robinson, Jamie R.; Marincola, Paula; Shelton, Julia; Merchant, Nipun; Idrees, Kamran; Parikh, Alexander A.

In: HPB, Vol. 17, No. 6, 01.06.2015, p. 495-501.

Research output: Contribution to journalArticle

Robinson, JR, Marincola, P, Shelton, J, Merchant, N, Idrees, K & Parikh, AA 2015, 'Peri-operative risk factors for delayed gastric emptying after a pancreaticoduodenectomy', HPB, vol. 17, no. 6, pp. 495-501. https://doi.org/10.1111/hpb.12385
Robinson, Jamie R. ; Marincola, Paula ; Shelton, Julia ; Merchant, Nipun ; Idrees, Kamran ; Parikh, Alexander A. / Peri-operative risk factors for delayed gastric emptying after a pancreaticoduodenectomy. In: HPB. 2015 ; Vol. 17, No. 6. pp. 495-501.
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AU - Parikh, Alexander A.

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N2 - 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.

AB - 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.

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