Delayed Gastric Emptying After Pancreaticoduodenectomy: an Analysis of Risk Factors and Cost

• DOI: 10.1007/s11605-015-2865-5
• Publication Date: 2015-07-13T15:47:19Z
• Authors: Joshua D. Eisenberg; Ernest L. Rosato; Harish Lavu; Charles J. Yeo; Jordan M. Winter
• Keywords: Adult; Aged, 80 and over; Male; Time Factors; Smoking; Stomach Diseases; Recovery of Function; Adenocarcinoma; Middle Aged; Digestive System Neoplasms; Pancreaticoduodenectomy; 3. Good health; 03 medical and health sciences; Sex Factors; 0302 clinical medicine; Gastric Emptying; Risk Factors; Multivariate Analysis; Humans; Intraabdominal Infections; Female; Aged; Retrospective Studies

Delayed gastric emptying (DGE) is a common complication after pancreaticoduodenectomy (PD), yet it remains incompletely understood. The International Study Group of Pancreatic Surgery (ISGPS) in 2007 defined a three-tiered grading system to standardize studies of DGE.In this study, 721 patients undergoing PD between 2006 and 2012 were retrospectively categorized by the ISGPS DGE criteria, as well as a modified grading system (termed primary DGE) if, on retrospective review, DGE was not believed to be a sequela of a separate complication. Predictive factors and associated outcomes were determined.ISGPS-defined DGE occurred in 140 (19.4%) patients. In a multivariate analysis, predictors of ISGPS-defined DGE included abdominal infection (odds ratio (OR) 5.5, p < 0.001), male gender (OR 1.92, p = 0.007), smoking history (OR 1.75 p = 0.033), and periampullary adenocarcinoma (OR 1.66, p = 0.041). Primary DGE occurred in 12.2% of patients. Predictors included abdominal infection (OR 3.15, p < 0.001) and smoking history (OR 2.04, p = 0.008). Median hospital charges increased over $10,000 with each severity grade of DGE (p < 0.001).DGE is common after PD and contributes substantially to cost. DGE is frequently a secondary complication of abdominal infection, and interventions that limit such complications may be the most effective strategy toward preventing DGE.