Elsevier

Surgery

Volume 156, Issue 4, October 2014, Pages 939-948
Surgery

Central Surgical Association
Optimal management of delayed gastric emptying after pancreatectomy: An analysis of 1,089 patients

Presented orally at the Central Surgical Association Annual Meeting, Indianapolis, Indiana, March 7, 2014.
https://doi.org/10.1016/j.surg.2014.06.024Get rights and content

Purpose

The aim of this study was to determine if early recognition and treatment of delayed gastric emptying (DGE) can augment postoperative outcomes in patients undergoing pancreatectomy.

Methods

The International Study Group of Pancreatic Surgery definition of DGE was used to identify patients at Indiana University Hospital who required supplemental nutrition for DGE after pancreatectomy. Outcomes were compared between those without DGE, those with DGE who received supplemental nutrition within 10 days after pancreatectomy (early intervention), and those treated after 10 days (late intervention).

Results

Between 2007 and 2012, the incidence of DGE was 15% (n = 163/1,089), 45% (n = 73) required supplemental nutrition, including 60% (n = 44/73) in the early intervention and 40% (n = 29/73) in the late intervention groups. Postoperative morbidity (62% vs 41%; P < .01), duration of stay (16 vs 7 days; P < .01), and readmissions (41% vs 17%; P < .01) were greater among those with DGE. The early intervention group resumed a regular diet sooner (day 24 vs 36; P = .05) and were readmitted less often (25% vs 65%; P < .01) than those in the late intervention group. Treatment-related complications occurred in 14% of patients.

Conclusion

Patients with DGE can be managed with acceptable treatment-related morbidity. Outcomes are best when supplemental nutrition is started within 10 days of operation.

Section snippets

Patient population and DGE definitions

The American College of Surgeons-National Surgical Quality Improvement Project is a validated, national program that collects prospectively patient characteristics, processes of care, and adverse outcomes to evaluate hospital performance with regard to surgical care.13 The American College of Surgeons-National Surgical Quality Improvement Project database at Indiana University Hospital was used to identify patients who underwent pancreatoduodenectomy or distal pancreatectomy between January

DGE

From 2007 to 2012, 708 patients underwent pancreatoduodenectomy and 381 underwent distal pancreatectomy. The overall incidence of DGE in 1,089 patients after pancreatectomy was 15% (n = 163). Patients who underwent pancreatoduodenectomy more likely to develop DGE (20%, n = 140/708) compared with those who underwent distal pancreatectomy (6% [n = 19/381]; P < .001). Of those with DGE, 45% (n = 73/163) were grades B or C and required supplemental nutrition, including 60% (n = 44/73) who received

Discussion

The incidence and clinical burden of DGE among patients undergoing pancreatectomy remains high. Much of the work published on DGE has focused on identifying risk factors associated with the development of DGE and its subsequent prevention. Most are small, single-institution series with substantial variability in the reported incidence and associated risk factors.4, 5, 6, 7, 8, 9, 10, 12 Despite the high incidence of DGE after pancreatectomy, evidence supporting its management is lacking, and

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