O. A. Hernandez Dominguez1, A. Grigorian1, R. F. Wolf1, D. K. Imagawa1, J. Nahmias2, Z. Jutric1 1University Of California – Irvine,Division Of Hepatobiliary & Pancreatic Surgery & Islet Cell Transplantation,Orange, CA, USA 2University Of California – Irvine,Division Of Trauma, Burns And Surgical Critical Care,Orange, CA, USA
Introduction: Delayed gastric emptying (DGE) is common in patients undergoing pancreaticoduodenectomy, with a wide range of reported rates in the literature. The effect of DGE on mortality is less clear. We sought to identify predictors of mortality in patients undergoing pancreaticoduodenectomy for adenocarcinoma specific to the presence of DGE.
Methods: The American College of Surgeons National Surgical Quality Improvement Program targeted pancreatectomy database (2014-2017) was queried for patients with pancreatic adenocarcinoma undergoing pancreaticoduodenectomy. A multivariable logistic regression analysis was performed. Separate sensitivity analyses were performed adjusting for pancreatic fistula grades A-C.
Results: Out of 8,011 patients undergoing pancreaticoduodenectomy, 1,246 had DGE (15.6%). When compared to patients without DGE, patients with DGE were older (median, 69 vs. 67 years old, p<0.001) more likely to be male (62.0% vs. 52.1%, p<0.001). A total of 8.5% of patients had no oral intake by post-operative day-14. The DGE group had a lower rate of preoperative chemotherapy (23.5% vs. 29.2%, p<0.001), longer median operative duration (373 vs. 362 minutes, p=0.019) and longer hospital length of stay (16.5 vs. 8 days, p<0.001). After adjusting for age, gender, comorbidities, preoperative chemotherapy/radiation, operative approach, vascular resection, deep organ space infection, postoperative percutaneous drain placement, and development of a pancreatic fistula, DGE was associated with increased risk for 30-day mortality (OR 3.25, 2.16-4.88, p<0.001). Gender, comorbidities, preoperative chemotherapy/radiation, and operative approach were not associated with 30-day mortality (all p>0.05). On sub-analysis, grades A and B pancreatic fistulas were not associated with risk of mortality while grade C fistula was associated with the highest risk of mortality (OR 5.64, 2.24-14.17, p<0.001).
Conclusion: The rate of DGE in patients undergoing pancreaticoduodenectomy in this large database was slightly greater than 15%. Furthermore, DGE is associated with greater than three times increased risk of mortality, even when controlling for pancreatic fistula and deep organ space infection.