TY - JOUR
T1 - Impact of feeding strategy after pancreatoduodenectomy on delayed gastric emptying and hospital stay
T2 - nationwide study
AU - Hendriks, Tessa E
AU - Strijbos, Bo T M
AU - Francken, Michiel F G
AU - Ali, Mahsoem
AU - Suurmeijer, J Annelie
AU - Dijkgraaf, Marcel G W
AU - Hopstaken, Jana S
AU - van Laarhoven, Kees
AU - Molenaar, Quintus
AU - de Meijer, Vincent E
AU - van der Harst, Erwin
AU - den Dulk, Marcel
AU - Draaisma, Werner
AU - Nieuwenhuijs, Vincent
AU - Gerhards, Michael F
AU - Liem, Mike S L
AU - van der Schelling, George
AU - Manusama, Eric
AU - de Hingh, Ignace
AU - van Santvoort, Hjalmar
AU - Groot Koerkamp, Bas
AU - Busch, Olivier R
AU - Bonsing, Bert A
AU - Stommel, Martijn W J
AU - Besselink, Marc G
N1 - Publisher Copyright:
© 2025 The Author(s). Published by Oxford University Press on behalf of BJS Foundation Ltd.
PY - 2025/5/7
Y1 - 2025/5/7
N2 - Background Delayed gastric emptying is a major contributor to prolonged hospital stay following pancreatoduodenectomy. Although enhanced recovery after surgery guidelines recommend unrestricted feeding after pancreatoduodenectomy, nationwide studies evaluating the impact of different feeding strategies after surgery on delayed gastric emptying and length of hospital stay are limited. This study aimed to identify the use and impact of different feeding strategies after pancreatoduodenectomy on delayed gastric emptying and length of hospital stay. Methods This nationwide cohort study included consecutive patients after pancreatoduodenectomy from the Dutch Pancreatic Cancer Audit (2021-2023). Primary endpoints were delayed gastric emptying grade B/C and length of hospital stay. Feeding strategies were categorized based on structured interviews with representatives from 15 centres. Multilevel analysis was used to assess associations between feeding strategy, delayed gastric emptying, and length of hospital stay. Predictors of delayed gastric emptying were determined. Results Overall, 2354 patients undergoing pancreatoduodenectomy were included, of whom 526 (23%) developed delayed gastric emptying grade B/C. Median length of hospital stay was 13 days longer in patients with delayed gastric emptying (23 versus 10 days; P < 0.001). Feeding strategies were: unrestricted feeding (3 centres, 637 patients; delayed gastric emptying 18%); step-up feeding (9 centres, 1462 patients; delayed gastric emptying 24%); and artificial feeding (3 centres, 255 patients; delayed gastric emptying 25%). No association was observed between feeding strategy and delayed gastric emptying: step-up versus unrestricted feeding (odds ratio 1.14, 95% confidence interval 0.53 to 2.47) and artificial versus unrestricted feeding (odds ratio 1.76, 0.65 to 4.73). Similarly, no association was found between feeding strategy and length of hospital stay. The strongest predictor of delayed gastric emptying was pancreatic fistula after surgery (odds ratio 3.16, 2.47 to 4.05). Conclusion This study found no significant association between feeding strategy and incidence of delayed gastric emptying or length of hospital stay after pancreatoduodenectomy. Efforts to reduce delayed gastric emptying should focus on reducing pancreatic fistula after surgery.
AB - Background Delayed gastric emptying is a major contributor to prolonged hospital stay following pancreatoduodenectomy. Although enhanced recovery after surgery guidelines recommend unrestricted feeding after pancreatoduodenectomy, nationwide studies evaluating the impact of different feeding strategies after surgery on delayed gastric emptying and length of hospital stay are limited. This study aimed to identify the use and impact of different feeding strategies after pancreatoduodenectomy on delayed gastric emptying and length of hospital stay. Methods This nationwide cohort study included consecutive patients after pancreatoduodenectomy from the Dutch Pancreatic Cancer Audit (2021-2023). Primary endpoints were delayed gastric emptying grade B/C and length of hospital stay. Feeding strategies were categorized based on structured interviews with representatives from 15 centres. Multilevel analysis was used to assess associations between feeding strategy, delayed gastric emptying, and length of hospital stay. Predictors of delayed gastric emptying were determined. Results Overall, 2354 patients undergoing pancreatoduodenectomy were included, of whom 526 (23%) developed delayed gastric emptying grade B/C. Median length of hospital stay was 13 days longer in patients with delayed gastric emptying (23 versus 10 days; P < 0.001). Feeding strategies were: unrestricted feeding (3 centres, 637 patients; delayed gastric emptying 18%); step-up feeding (9 centres, 1462 patients; delayed gastric emptying 24%); and artificial feeding (3 centres, 255 patients; delayed gastric emptying 25%). No association was observed between feeding strategy and delayed gastric emptying: step-up versus unrestricted feeding (odds ratio 1.14, 95% confidence interval 0.53 to 2.47) and artificial versus unrestricted feeding (odds ratio 1.76, 0.65 to 4.73). Similarly, no association was found between feeding strategy and length of hospital stay. The strongest predictor of delayed gastric emptying was pancreatic fistula after surgery (odds ratio 3.16, 2.47 to 4.05). Conclusion This study found no significant association between feeding strategy and incidence of delayed gastric emptying or length of hospital stay after pancreatoduodenectomy. Efforts to reduce delayed gastric emptying should focus on reducing pancreatic fistula after surgery.
KW - Aged
KW - Cohort Studies
KW - Enteral Nutrition/methods
KW - Female
KW - Gastric Emptying
KW - Gastroparesis/etiology
KW - Humans
KW - Length of Stay/statistics & numerical data
KW - Male
KW - Middle Aged
KW - Netherlands/epidemiology
KW - Pancreaticoduodenectomy/adverse effects
KW - Postoperative Complications/epidemiology
U2 - 10.1093/bjsopen/zraf068
DO - 10.1093/bjsopen/zraf068
M3 - Article
C2 - 40512076
SN - 2474-9842
VL - 9
JO - BJS open
JF - BJS open
IS - 3
M1 - zraf068
ER -