Perioperative nutritional practices and associations with delayed gastric emptying in patients undergoing a pancreaticoduodenectomy: A retrospective observational study

AIMS: Delayed gastric emptying is a common complication of a pancreaticoduodenectomy and can adversely impact nutritional status, and potentially clinical outcomes due to delays in nutrition initiation post-operatively. The aim of this study was to explore associations between delayed gastric emptying and patient baseline characteristics, early post-operative nutritional status, post-operative nutritional practices and clinical outcomes in a tertiary Australian hospital. METHODS: This was a retrospective, observational study of 80 consecutive patients who underwent a pancreaticoduodenectomy between January 2019 and June 2022. Delayed gastric emptying was classified according to the International Study Group of Pancreatic Surgery definition. Continuous variables were compared using the independent t test, and categorical variables were compared using chi-squared or Fisher's exact test. Significant variables were included in a multivariable model. RESULTS: The incidence of delayed gastric emptying within this cohort was 45% (36/80) and was higher in males compared to females (p = 0.025). Early post-operative nutritional status was not significantly associated with delayed gastric emptying (p = 0.124). Patients with delayed gastric emptying had a higher incidence of post-operative pancreatic fistula (p = 0.03) and Clavien-Dindo complications ≥3 (p = 0.011). Delayed gastric emptying was associated with greater usage of enteral (p < 0.001) and parenteral nutrition (p < 0.001), a longer length of stay (p < 0.001) and increased re-admissions (p = 0.014). Male sex remained significantly associated with delayed gastric emptying following regression analysis. CONCLUSIONS: Delayed gastric emptying rates were high, associated with greater use of artificial nutrition and worse outcomes in our patient population post-operatively. Early post-operative malnutrition was not significantly associated with delayed gastric emptying.