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Comparison of Routine Versus Selective Nasogastric Decompression Following Pancreaticoduodenectomy
*John W Kunstman, *Nicholas D Klemen, *Annabelle L Fonseca, *Deborah L Araya, Ronald R Salem
Yale University, New Haven, CT

Objective: Limited data exists for the utility of nasogastric decompression following pancreaticoduodenectomy (PD), where post-operative nasogastric tube (NGT) use remains the standard of care. This study seeks to evaluate the effects of routine versus selective NGT employment following PD on patient outcomes and post-operative course.
Design: Retrospective cohort of a prospective dataset
Setting: Academic tertiary center
Patients: 250 patients underwent PD between 7/03 and 2/12 by a single surgeon. The average patient age was 63.4 years and the most common indication was pancreatic neoplasm. Prior to 7/08, NGTs placed intraoperatively were maintained until clinically indicated in all patients. Following 7/08, NGTs were selectively maintained only in rare occasions such as inability to extubate the patient post-operatively.
Interventions: N/A
Main Outcome Measures: The primary outcomes evaluated were need for NGT insertion/reinsertion, delayed gastric emptying (DGE) incidence, time to dietary tolerance, and length of stay. Secondary analysis examined overall surgical morbidity using the Clavien-Dindo system and additional specific complications of interest.
Results: 125 consecutive patients in both the routine and selective NGT placement groups were evaluated in an intent-to-treat manner. In the selective group, NGTs were maintained in 9 patients post-operatively (7.2%). Need for NGT insertion/reinsertion did not differ significantly between selective and routine groups (8% versus 4.8%, respectively). Patients in the selective group had significantly decreased incidence of DGE (p=0.015), length of stay (p<0.001), and time to dietary tolerance (p<0.001). Overall complication rates were similar; however, patients in the selective group had fewer respiratory complications requiring re-intubation (p=0.025).
Conclusion: Routine post-operative nasogastric decompression in patients undergoing pancreaticoduodenectomy is unnecessary and may increase adverse events and length of stay. Selective NGT usage appears an appropriate treatment strategy.

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May 5, 2014

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August 13, 2014

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August 11, 2014
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