Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Mar 27;9(3):73-81.
doi: 10.4240/wjgs.v9.i3.73.

Delayed gastric emptying following pancreaticoduodenectomy: Incidence, risk factors, and healthcare utilization

Somala Mohammed  1 , George Van Buren Ii  1 , Amy McElhany  1 , Eric J Silberfein  1 , William E Fisher  1
Affiliations

Delayed gastric emptying following pancreaticoduodenectomy: Incidence, risk factors, and healthcare utilization

Somala Mohammed et al. World J Gastrointest Surg. .

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.

PubMed Disclaimer

Conflict of interest statement

Conflict-of-interest statement: None of the authors have any relevant conflicts of interest or personal or financial relationships to disclose.

Figures

Figure 1
Figure 1
Incidence of post-operative delayed gastric emptying following pancreaticoduodenectomy. Among a cohort of 276 patients, 49 (17.8%) developed DGE. Among the 49 patients with DGE, 25 developed grade A DGE (representing 9.1% of the overall cohort of 276 patients), 14 developed grade B (5.1% of the overall cohort), and 10 developed grade C DGE (3.6% of the overall cohort). DGE: Delayed gastric emptying.
Figure 2
Figure 2
Health care utilization associated with delayed gastric emptying. Patients with DGE had a longer hospital stay (median 12 d vs 7 d, P < 0.001) and were more likely to be discharged to transitional care facilities (24.5% vs 6.6%, P < 0.001). DGE: Delayed gastric emptying.
See this image and copyright information in PMC

References

    1. Schmidt CM, Turrini O, Parikh P, House MG, Zyromski NJ, Nakeeb A, Howard TJ, Pitt HA, Lillemoe KD. Effect of hospital volume, surgeon experience, and surgeon volume on patient outcomes after pancreaticoduodenectomy: a single-institution experience. Arch Surg. 2010;145:634–640. - PubMed
    1. Cameron JL, Pitt HA, Yeo CJ, Lillemoe KD, Kaufman HS, Coleman J. One hundred and forty-five consecutive pancreaticoduodenectomies without mortality. Ann Surg. 1993;217:430–435; discussion 435-438. - PMC - PubMed
    1. Fernández-del Castillo C, Rattner DW, Warshaw AL. Standards for pancreatic resection in the 1990s. Arch Surg. 1995;130:295–299; discussion 299-300. - PubMed
    1. Lieberman MD, Kilburn H, Lindsey M, Brennan MF. Relation of perioperative deaths to hospital volume among patients undergoing pancreatic resection for malignancy. Ann Surg. 1995;222:638–645. - PMC - PubMed
    1. Yeo CJ, Cameron JL, Sohn TA, Lillemoe KD, Pitt HA, Talamini MA, Hruban RH, Ord SE, Sauter PK, Coleman J, et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg. 1997;226:248–257; discussion 257-260. - PMC - PubMed

LinkOut - more resources