Predictors and outcomes of jejunostomy tube placement at the time of pancreatoduodenectomy
| Autor: | Robert E. Roses, Andrew D. Tieniber, Major K. Lee, Yun Song, Giorgos C. Karakousis, Rachel R. Kelz, Douglas L. Fraker, Charles M. Vollmer |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Gastroparesis Databases Factual medicine.medical_treatment Jejunostomy 030230 surgery Pancreaticoduodenectomy Pancreatic Fistula 03 medical and health sciences Postoperative Complications 0302 clinical medicine Risk Factors medicine Humans Practice Patterns Physicians' Aged Retrospective Studies Aged 80 and over Jejunostomy tubes Gastric emptying business.industry Guideline Odds ratio Middle Aged medicine.disease United States Surgery Logistic Models Treatment Outcome Pancreatic fistula 030220 oncology & carcinogenesis Practice Guidelines as Topic Pancreatectomy Tube placement Female Guideline Adherence business Procedures and Techniques Utilization |
| Zdroj: | Surgery. 165:1136-1143 |
| ISSN: | 0039-6060 |
| DOI: | 10.1016/j.surg.2019.03.007 |
| Popis: | Clinically relevant postoperative pancreatic fistula and delayed gastric emptying cause substantial morbidity after pancreatoduodenectomy. Per international guidelines, the placement of jejunostomy tubes may be considered for patients at risk for malnutrition, such as those with a high risk for clinically relevant postoperative pancreatic fistula and related complications. This study determined predictors and postoperative outcomes of jejunostomy tube placement.Patients undergoing pancreatoduodenectomy in 2014 to 2015 were identified using the American College of Surgeons National Surgical Quality Improvement Program and Procedure-Targeted Pancreatectomy Participant Use Files. Multivariable logistic regressions were used to identify factors associated with concurrent jejunostomy tube placement and postoperative outcomes.Of 3,600 patients, 8.9% underwent jejunostomy tube placement. Patients given a jejunostomy tube were more likely white (odds ratio 1.46, P = .016), to have low preoperative serum albumin levels (odds ratio 2.13, P.001), to have received neoadjuvant radiotherapy (odds ratio 2.14, P.001), and to have received an intraoperative transfusion (odds ratio 1.50, P = .004). We observed no association between jejunostomy tube placement and an increasing number of risk factors for clinically relevant postoperative pancreatic fistula (P = .96) or delayed gastric emptying (P = .54). Overall, jejunostomy tube placement was associated with increased morbidity (odds ratio 1.34, P = .020) and duration of stay (P.001), but not mortality (P = .12). Among patients with low serum albumin or those who developed clinically relevant postoperative pancreatic fistula or delayed gastric emptying, jejunostomy tube utilization was not associated with morbidity or mortality.Jejunostomy tube placement during pancreatoduodenectomy was not driven by risk factors for clinically relevant postoperative pancreatic fistula or delayed gastric emptying, suggesting that practice patterns play a role. Among patients with at-risk preoperative albumin or who developed these complications, jejunostomy tube placement was not associated with worse outcomes, supporting selective utilization per guideline recommendations. |
| Databáze: | OpenAIRE |
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