Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Mar 27, 2017; 9(3): 73-81
Published online Mar 27, 2017. doi: 10.4240/wjgs.v9.i3.73
Delayed gastric emptying following pancreaticoduodenectomy: Incidence, risk factors, and healthcare utilization
Somala Mohammed, George Van Buren II, Amy McElhany, Eric J Silberfein, William E Fisher
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
Author contributions: Mohammed S, Van Buren II G and Fisher WE contributed to the design and conception of this work; Mohammed S, Van Buren II G, McElhany A and Fisher WE contributed to acquisition of data; all authors contributed to analysis and interpretation of the data; Mohammed S, Van Buren II G and Fisher WE contributed to drafting of the manuscript; and all authors reviewed, revised, and approved the version to be submitted.
Institutional review board statement: This study was approved by the Baylor College of Medicine Institutional Review Board.
Informed consent statement: All patients whose data contributed to this study provided informed written consent to be included in a prospectively-maintained, IRB-approved institutional database for research.
Conflict-of-interest statement: None of the authors have any relevant conflicts of interest or personal or financial relationships to disclose.
Data sharing statement: All patients whose data contributed to this study provided informed written consent to be included in a prospectively-maintained, IRB-approved institutional database for research. The presented work includes de-identified data in summary form only and the risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: William E Fisher, MD, FACS, Professor and Chief of Division of General Surgery, Chair of General Surgery, Director, Elkins Pancreas Center, Michael E DeBakey Department of Surgery, Baylor College of Medicine, 6620 Main Street, Suite 1450, Houston, TX 77030, United States. wfisher@bcm.edu
Telephone: +1-832-3551490 Fax: +1-713-6102489
Received: July 15, 2016
Peer-review started: July 17, 2016
First decision: September 2, 2016
Revised: October 28, 2016
Accepted: December 1, 2016
Article in press: December 2, 2016
Published online: March 27, 2017
Processing time: 251 Days and 12.2 Hours
Abstract
AIM

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% vs 4.4%, ≥ 3 complications, P < 0.001), including postoperative pancreatic fistula (POPF) (42.9% vs 18.9%, P = 0.001) and intra-abdominal abscess (IAA) (16.3% vs 4.0%, P = 0.012). Patients with DGE had longer hospital stay (median, 12 d vs 7 d, P < 0.001) and were more likely to require transitional care upon discharge (24.5% vs 6.6%, 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].

CONCLUSION

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.

Keywords: Delayed gastric emptying; Pancreaticoduodenectomy; Post-operative pancreatic fistula

Core tip: Delayed gastric emptying (DGE) frequently occurs following pancreaticoduodenectomy. Review of our institutional database revealed a DGE rate of less than 20% among patients who underwent PD. DGE was associated with increased healthcare utilization in terms of rates of various postoperative complications, length of hospital stay, and need for transitional care upon discharge. Patients with post-operative pancreatic fistula or intra-abdominal abscess formation were at risk for DGE. Anticipating DGE can help individualize care and allocate resources to high-risk patients.