Risk factors for post-pancreaticoduodenectomy delayed gastric emptying in the absence of pancreatic fistula or deep surgical site infection

Abstract

Introduction: Delayed gastric emptying (DGE) is a common complication following pancreaticoduodenectomy. Pancreatic fistula or deep surgical site infection (SSI) may contribute to development of DGE, but less is known about risk factors for DGE in the absence of these other complications. Our objective was to explore risk factors for postoperative DGE in patients without pancreatic fistula or deep SSI. Methods: American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) pancreatectomy variables were used to identify patients with DGE following pancreaticoduodenectomy. Multivariable models were developed to assess preoperative, intraoperative, and technical factors associated with DGE. Results: A total of 10,614 pancreaticoduodenectomies were identified with an overall DGE rate of 17.1%. DGE was not associated with pancreatic fistula or deep SSI in 56% of cases. The rate of DGE was 11.9% in patients without pancreatic fistula or deep SSI. These patients were more likely to develop DGE if age ≥75 (OR 1.29 [95%CI 1.09-1.52]), male (OR 1.44 [95% CI 1.26–1.65]), black race (OR 1.25 [95% CI 1.01–1.55]), or underwent pylorus-sparing pancreaticoduodenectomy (OR 1.31 [95% CI 1.08–1.58]). Factors not associated with DGE included diabetes, BMI, malignancy, open/laparoscopic approach, and antecolic/retrocolic gastric reconstruction. Conclusion: The incidence of DGE after pancreaticodudenectomy is notable even in patients without other abdominal complications. Identification of patients at increased risk for DGE can be used to make more informed decisions regarding selective use of pylorus-sparing pancreaticoduodenectomy, enteral feeding access, nasogastric tubes, and adjustment of enhanced recovery pathways.