POST- AND INTRA-OPERATIVE FACTORS ASSOCIATED WITH DEVELOPMENT OF DELAYED GASTRIC EMPTYING AFTER PANCREATICODUODENECTOMY
Neda Amini*1,2, Christopher R. D'Adamo2, Arun Mavanur2
1Surgery, Johns Hopkins, Baltimore , MD; 2Sinai Hospital, Baltimore, MD
Introduction: Delayed gastric emptying (DGE) is a common complication after pancreaticoduodenectomy. The purpose of this study was to evaluate potential factors associated with development of DGE after pancreaticoduodenectomy.
Methods: Data from the 2014-2018 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) targeted pancreatectomy variables, were utilized in this retrospective study. Patients with CPT codes for pancreaticoduodenectomy procedures (CPT = 48150, 48152, 48153, 48154) were included in the analysis. Patient and procedural characteristics of interest were age, sex, obesity, diabetes, modified frailty index, operative technique (classic vs. pylorus-sparing), transfusion, morbidity (superficial SSI, deep incisional SSI, organ space SSI, wound disruption, pneumonia, unplanned intubation, pulmonary embolism, deep vein thrombosis, ventilator >48 hours, progressive renal insufficiency, acute renal failure, urinary tract infection, stroke, cardiac arrest, myocardial infarction, return to operating room, and postoperative sepsis), and pancreatic fistula. Chi-square tests and multivariate logistic regression modeling were conducted to evaluate bivariate associations between patient and procedural characteristics of interest and delayed gastric emptying. All analyses were performed in SAS Version 9.4.1
Results: A total of 15,851 patients were included. A total number of 2,580 (16.3%) patients developed DGE. In multivariable analysis male sex (Odds Ratio [OR] = 1.43, 95% Confidence Interval [CI] = [1.16, 1.76], p = 0.009), age (OR = 1.01, 95% CI = 1.01, 1.02, p = 0.03), blood transfusion (OR =1.38, 95% CI = 1.09, 1.75, p = 0.007), morbidity (OR = 2.27, 95% CI = [1.82, 2.83], p < 0.0001), and pancreatic fistula (OR = 2.792, 95% CI = [2.21, 3.53], p < 0.0001) were associated with risk of DGE.
Conclusion: A substantial number of patients developed DGE after pancreaticoduodenectomy. Operative technique was not associated with DGE. However, post-operative complications such as gastric fistula and post-op morbidity were associated with increased risk of DGE and should be monitored in this respect.
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