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.

High SSI rates following complex HPB operations can be improved by a multifactorial approach that features process improvements, individual surgeon feedback and reduced variation in patient management.

Introduction Improvements in the ability to predict pancreatic fistula could enhance patient outcomes. Previous studies demonstrate that drain fluid amylase on postoperative day 1 (DFA1) is predictive of pancreatic fistula. We sought to assess the accuracy of DFA1 and to identify a reliable DFA1 threshold under which pancreatic fistula is ruled out. Methods Patients undergoing pancreatic resection from November 1, 2011 to December 31, 2012 were selected from the American College of Surgeons-National Surgical Quality Improvement Program Pancreatectomy Demonstration Project data-base. Pancreatic fistula was defined as drainage of amylase-rich fluid with drain continuation >7 days, percutaneous drainage, or reoperation for a pancreatic fluid collection. Univariate and multi-variable regression models were utilized to identify factors predictive of pancreatic fistula. Results DFA1 was recorded in 536 of 2,805 patients who underwent pancreatic resection, including pancreaticoduodenectomy (n=380), distal pancreatectomy (n=140), and enucleation (n=16). Pancreatic fistula occurred in 92/536 (17.2 %) patients. DFA1, increased body mass index, small pancreatic duct size, and soft texture were associated with fistula (p<0.05). A DFA1 cutoff value of <90 U/L demonstrated the highest negative predictive value of 98.2 %. Receiver operating characteristic (ROC) curve confirmed the predictive relationship of DFA1 and pancreatic fistula. Conclusion Low DFA1 predicts the absence of a pancreatic fistula. In patients with DFA1<90 U/L, early drain removal is advisable.

STRUCTURED ABSTRACT OBJECTIVE AND SUMMARY BACKGROUND DATA For pancreatectomy patients, mortality increases with increasing age. Our study evaluated the relative contribution of overall postoperative complications and failure to rescue rates on the observed increased mortality in older patients undergoing pancreatic resection at specialized centers. METHODS We identified 2,694 patients who underwent pancreatic resection from the ACS-NSQIP Pancreatectomy Demonstration Project at 37 high volume centers. Overall morbidity and in-hospital mortality were determined in patients <80 (N=2,496) and ≥80 (N=198) years old. Failure to rescue was the number of deaths in patients with complications divided by the total number of patients with postoperative complications. RESULTS No significant differences were observed between patients <80 and ≥80 in the rates of overall complications (41.4% vs. 39.4%, p=0.58). In-hospital mortality increased in patients ≥80 compared to patients <80 (3.0% vs. 1.1%, p=0.02). Failure to rescue rates were higher in patients ≥80 (7.7% vs. 2.7%, p=0.01). Across 37 high volume centers, unadjusted complication rates ranged from 25.0%–72.2% and failure to rescue rates ranged from 0.0%–25.0%. Among patients with postoperative complications, comorbidities associated with failure to rescue were ascites, COPD, and diabetes. Complications associated with failure to rescue included acute renal failure, septic shock, and postoperative pulmonary complications. CONCLUSION In experienced hands, the rates of complications after pancreatectomy in patients ≥80 compared to patients <80 were similar. However, when complications occurred, older patients were more likely to die. Interventions to identify and aggressively treat complications are necessary to decrease mortality in vulnerable older patients.