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Feeding jejunostomy tube placement in patients undergoing pancreaticoduodenectomy: an ongoing dilemma.

Publication ,  Journal Article
Nussbaum, DP; Zani, S; Penne, K; Speicher, PJ; Stinnett, SS; Clary, BM; White, RR; Tyler, DS; Blazer, DG
Published in: J Gastrointest Surg
October 2014

BACKGROUND: Concomitant placement of feeding jejunostomy tubes (FJT) during pancreaticoduodenectomy is common, yet there are limited data regarding catheter-specific morbidity and associated outcomes. This information is crucial to appropriately select patients for feeding tube placement and to optimize perioperative nutrition strategies. METHODS: A review of all patients undergoing pancreaticoduodenectomy with FJT placement was completed. Patients were grouped by the occurrence of FJT-related morbidity. Multivariable logistic regression was performed to identify predictors of FJT morbidity; these complications were then further defined. Finally, associated postoperative outcomes were compared between groups. RESULTS: In total, 126 patients were included, of which 18 (14 %) had complications directly related to their FJT, including pericatheter infection (n = 6), pneumatosis intestinalis (n = 4), severe tube feed intolerance (n = 3), and primary catheter malfunction (n = 7). Following adjustment with logistic regression, preoperative hypoalbuminemia was identified as the only independent predictor of FJT complications (OR 2.23, p = 0.035). Patients with FJT complications were more likely to be initiated on total parenteral nutrition (TPN; 55.6 vs. 7.4 %, p -0.035) and to require TPN at discharge (16.7 vs. 0%, p = 0.003). Correspondingly, these patients resumed an oral diet later (14 vs. 8 days, p = 0.06). Both reoperation (50.0 vs. 6.5%, p < 0.001) and readmission (50.0 vs. 22.4%, p = 0.041) rates were higher among patients with FJT complications. CONCLUSIONS: FJT-related morbidity is common among patients undergoing pancreaticoduodenectomy and is associated with inferior outcomes and other performance metrics. Preoperative malnutrition appears to predict FJT complications, creating an ongoing dilemma regarding FJT placement. In the future, it will be important to better define criteria for FJT placement during pancreaticoduodenectomy.

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Published In

J Gastrointest Surg

DOI

EISSN

1873-4626

Publication Date

October 2014

Volume

18

Issue

10

Start / End Page

1752 / 1759

Location

Netherlands

Related Subject Headings

  • United States
  • Treatment Outcome
  • Surgery
  • Retrospective Studies
  • Reoperation
  • Postoperative Period
  • Postoperative Complications
  • Pancreaticoduodenectomy
  • Pancreatic Neoplasms
  • Nutritional Status
 

Citation

APA
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Nussbaum, D. P., Zani, S., Penne, K., Speicher, P. J., Stinnett, S. S., Clary, B. M., … Blazer, D. G. (2014). Feeding jejunostomy tube placement in patients undergoing pancreaticoduodenectomy: an ongoing dilemma. J Gastrointest Surg, 18(10), 1752–1759. https://doi.org/10.1007/s11605-014-2581-6
Nussbaum, Daniel P., Sabino Zani, Kara Penne, Paul J. Speicher, Sandra S. Stinnett, Bryan M. Clary, Rebekah R. White, Douglas S. Tyler, and Dan G. Blazer. “Feeding jejunostomy tube placement in patients undergoing pancreaticoduodenectomy: an ongoing dilemma.J Gastrointest Surg 18, no. 10 (October 2014): 1752–59. https://doi.org/10.1007/s11605-014-2581-6.
Nussbaum DP, Zani S, Penne K, Speicher PJ, Stinnett SS, Clary BM, et al. Feeding jejunostomy tube placement in patients undergoing pancreaticoduodenectomy: an ongoing dilemma. J Gastrointest Surg. 2014 Oct;18(10):1752–9.
Nussbaum, Daniel P., et al. “Feeding jejunostomy tube placement in patients undergoing pancreaticoduodenectomy: an ongoing dilemma.J Gastrointest Surg, vol. 18, no. 10, Oct. 2014, pp. 1752–59. Pubmed, doi:10.1007/s11605-014-2581-6.
Nussbaum DP, Zani S, Penne K, Speicher PJ, Stinnett SS, Clary BM, White RR, Tyler DS, Blazer DG. Feeding jejunostomy tube placement in patients undergoing pancreaticoduodenectomy: an ongoing dilemma. J Gastrointest Surg. 2014 Oct;18(10):1752–1759.
Journal cover image

Published In

J Gastrointest Surg

DOI

EISSN

1873-4626

Publication Date

October 2014

Volume

18

Issue

10

Start / End Page

1752 / 1759

Location

Netherlands

Related Subject Headings

  • United States
  • Treatment Outcome
  • Surgery
  • Retrospective Studies
  • Reoperation
  • Postoperative Period
  • Postoperative Complications
  • Pancreaticoduodenectomy
  • Pancreatic Neoplasms
  • Nutritional Status