Predictors of Delayed Gastric Emptying in Patients Undergoing Distal Pancreatic Resection

Background: Delayed gastric emptying (DGE) is the most common postoperative complication following any pancreatic resection. The incidence and risk factors of DGE in patients undergoing distal pancreatic resection (DPR) is not well defined. We aimed to determine the incidence of DGE not associated with postoperative pancreatic fistula (POPF) in patients undergoing DPR and to identify predictors of DGE. Methods: ACS-NSQIP pancreatectomy database (2014-2017) was queried for patients with pancreatic adenocarcinoma undergoing DPR, excluding patients with POPF. A classification and regression tree (CART) analysis was performed to identify risk for DGE, defined by nasogastric/gastrostomy tube placed after postoperative day (POD) 7 or no oral intake by POD 14. Results: A total of 1626 patients underwent DPR without POPF; 59 had DGE (3.6%). Patients with DGE had a longer length of stay vs patients without DGE (median 15 vs 6 days, P < .001). CART analysis showed vascular resection and open surgery were predictors of DGE with a specificity of 98.3%. Patients requiring vascular resection had a 7.8% rate of DGE. Patients who did not undergo open surgery or vascular resection had a 1.8% rate of DGE. Conclusions: The rate of DGE in patients undergoing DPR without postoperative pancreatic fistula is low. Predictors of DGE include open surgical approach and vascular resection. These findings may be utilized to counsel patients and take precautions in those at greater risk of developing DGE. Further research can involve implementation of a scoring tool to help stratify patients at risk for DGE after DPR.