Factors associated with delayed gastric emptying after pancreaticoduodenectomy

Parmar, Abhishek D.; Sheffield, Kristin M.; Vargas, Gabriela; Pitt, Henry A.; Kilbane, E. Molly; Hall, Bruce L.; Riall, Taylor S.

doi:10.1111/hpb.12129

Cited by 116 publications

(106 citation statements)

References 42 publications

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“…21 Further details regarding the PDP have previously been published. [22][23][24][25][26] Study patients During the study period, 2805 patients underwent a pancreatic resection at the 43 participating institutions. Patients who underwent total pancreatectomy, distal pancreatectomy, enucleation, and minimally invasive PD were excluded.…”

Section: Pancreatectomy Demonstration Projectmentioning

confidence: 99%

“…The primary outcomes of this study were perioperative overall morbidity, serious morbidity as previously defined, [22][23][24][25][26] mortality, and POPF-associated mortality. Aside from the variables collected by general participation in ACS-NSQIP, the 43 institutions participating in the PDP recorded 24 additional pancreatectomyspecific variables.…”

Section: Outcome Measuresmentioning

confidence: 99%

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Leakage of an Invagination Pancreaticojejunostomy May Have an Influence on Mortality

Lavu

McCall

Keith

et al. 2018

Journal of Pancreatic Cancer

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Purpose: No consensus exists regarding the most effective form of pancreaticojejunostomy (PJ) following pancreaticoduodenectomy (PD). Methods: Data were gathered through the American College of Surgeons-National Surgical Quality Improvement Program, Pancreatectomy Demonstration Project. A total of 1781 patients underwent a PD at 43 institutions. After appropriate exclusions, 890 patients were analyzed. Patients were divided into duct-to-mucosa (n = 734, 82%) and invagination (n = 156, 18%) groups and were compared by unadjusted analysis. Type of PJ was included in eight separate morbidity and mortality multivariable analyses. Results: Invagination patients had higher serum albumin ( p < 0.01) and lower body mass index ( p < 0.01), were less likely to have a preoperative biliary stent ( p < 0.01), and were more likely to have a soft gland ( p < 0.01). PJ anastomosis type was not associated with morbidity but was associated with mortality (duct-to-mucosa vs. invagination, odds ratio = 0.22, p < 0.01). Among patients who developed a clinically relevant pancreatic fistula, none of the 119 duct-to-mucosa, compared with 5 of 21 invagination, patients died ( p < 0.01). Conclusion: Patients who undergo a PJ by duct-to-mucosa or invagination differ with respect to preoperative and intraoperative variables. When an invagination PJ leaks, there may be a greater influence on mortality than when a duct-to-mucosa PJ leaks.

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Section: Pancreatectomy Demonstration Projectmentioning

confidence: 99%

Section: Outcome Measuresmentioning

confidence: 99%

Leakage of an Invagination Pancreaticojejunostomy May Have an Influence on Mortality

Lavu

McCall

Keith

et al. 2018

Journal of Pancreatic Cancer

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“…The American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) is a standardized multicenter national database that prospectively collects multiple preoperative demographic, laboratory, and comorbidity variables to provide robust riskadjusted rates of overall postoperative morbidity and mortality rates (11)(12)(13). The ACS-NSQIP Pancreatectomy Demonstration Project was piloted in 2011; its goal was to evaluate the feasibility of prospective collection of variables relevant for short-term outcomes following pancreatectomy.…”

Section: Data Sourcementioning

confidence: 99%

“…Pancreatic fistulas were considered to be clinically significant if they required percutaneous drainage or reoperation. Detailed definitions of these variables and database have been published elsewhere (13,14).…”

Section: Variablesmentioning

confidence: 99%

508 Does the Use of Neoadjuvant Therapy for Pancreatic Adenocarcinoma Increase Postoperative Morbidity and Mortality Rates?

Cooper¹,

Parmar²,

Hall³

et al. 2014

Gastroenterology

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“…The ACS-NSQIP Pancreatectomy Demonstration Project, for instance, seeks to provide a multitude of HPB-specific variables (preoperative biliary stent placement, pancreatic duct diameter and remnant gland texture, anastomotic technique and vascular resection, drain placement and amylase levels, rates of PF, and delayed gastric emptying (DGE)) so that outcomes researchers can address very precise questions on a much broader scale. [21][22][23] As an example, this pilot database has been utilized by Parmar et al 24 to identify PF formation, postoperative sepsis and reoperation as independent predictors of DGE following PD or total pancreatectomy. Similarly, multicenter consortiums are primed tools for investigating questions related to subspecialty-specific surgical outcomes and harbor the added benefit of promoting widespread collaboration and idea sharing among various facilities.…”

mentioning

confidence: 99%

How Does Outcomes Research Help Advance Our Knowledge of Patient Outcomes in Hepatopancreaticobiliary Surgery?

Alvino

Chang

Fong

2016

Journal of Gastrointestinal Surgery

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Randomized controlled trials have historically been regarded as the gold standard of modern clinical research tools, allowing us to elucidate the efficacy of novel therapeutics in an unparalleled manner. However, when attempting to generalize trial results to broader populations, it becomes apparent that the unexplained outcome variability exists among treatment recipients, suggesting that randomized controlled trials harbor inherent limitations. Herein, we explore the benefits of health services (outcomes) research utilization in addressing variation in patient outcomes following surgical intervention in the nonrandomized setting, with a specific focus on hepatopancreaticobiliary surgery outcomes. To achieve this, we have constructed a framework that outlines the complex interactions existing between therapeutic, patient, and provider factors that subsequently lead to variation in outcomes. By exploring examples in the current literature, we have highlighted the areas where the knowledge is currently lacking and can be further strengthened through the application of outcomes research. Furthermore, we have attempted to demonstrate the utility of alternative study designs in the investigation of novel clinical questions currently unanswered in the field of hepatopancreaticobiliary surgery.Keywords Health services research . Outcomes . Pancreas . Hepatopancreaticobiliary surgeryIn the era of modern medicine, randomized controlled trials (RCTs) have played an integral role in elucidating the efficacy of breakthrough therapeutic modalities. More recently, health services (outcomes) research has risen as another form of research methodology. Outcomes research may be even more valuable in a subspecialized field such as hepatopancreaticobiliary (HPB) surgery, in which RCTs are less commonplace than in other subspecialties, likely due to lower overall incidence rates of pathology and limited availability of study participants.

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Factors associated with delayed gastric emptying after pancreaticoduodenectomy

Abstract: In this multicentre study, only post-operative complications were associated with DGE. Neither pylorus preservation nor route of enteric reconstruction (antecolic versus retrocolic) was associated with delayed gastric emptying.

Cited by 116 publications

References 42 publications

Leakage of an Invagination Pancreaticojejunostomy May Have an Influence on Mortality

Leakage of an Invagination Pancreaticojejunostomy May Have an Influence on Mortality

508 Does the Use of Neoadjuvant Therapy for Pancreatic Adenocarcinoma Increase Postoperative Morbidity and Mortality Rates?

How Does Outcomes Research Help Advance Our Knowledge of Patient Outcomes in Hepatopancreaticobiliary Surgery?

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