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The PrEDICT-DGE score as a simple preoperative screening tool identifies patients at increased risk for delayed gastric emptying after pancreaticoduodenectomy
HPB ( IF 2.9 ) Pub Date : 2021-06-24 , DOI: 10.1016/j.hpb.2021.06.417
Gregor Werba 1 , Andrew D Sparks 1 , Paul P Lin 1 , Lynt B Johnson 1 , Khashayar Vaziri 1
Affiliation  

Background

Morbidity after Pancreaticoduodenectomy (PD) has remained unchanged over the past decade. Delayed Gastric Emptying (DGE) is a major contributor with significant impact on healthcare-costs, quality of life and, for malignancies, even survival. We sought to develop a scoring system to aid in easy preoperative identification of patients at risk for DGE.

Methods

The ACS-NSQIP dataset from 2014 to 2018 was queried for patients undergoing PD with Whipple or pylorus preserving reconstruction. 15,154 patients were analyzed using multivariable logistic regression to identify risk factors for DGE, which were incorporated into a prediction model. Subgroup analysis of patients without SSI or fistula (primary DGE) was performed.

Results

We identified 9 factors independently associated with DGE to compile the PrEDICT-DGE score: Procedures (Concurrent adhesiolysis, feeding jejunostomy, vascular reconstruction with vein graft), Elderly (Age>70), Ductal stent (Lack of biliary stent), Invagination (Pancreatic reconstruction technique), COPD, Tobacco use, Disease, systemic (ASA>2), Gender (Male) and Erythrocytes (preoperative RBC-transfusion). PrEDICT-DGE scoring strongly correlated with actual DGE rates (R2 = 0.95) and predicted patients at low, intermediate, and high risk.

Subgroup analysis of patients with primary DGE, retained all predictive factors, except for age>70 (p = 0.07) and ASA(p = 0.30).

Conclusion

PrEDICT-DGE scoring accurately identifies patients at high risk for DGE and can help guide perioperative management.



中文翻译:

PrEDICT-DGE 评分作为一种简单的术前筛查工具,可识别胰十二指肠切除术后胃排空延迟风险增加的患者

背景

胰十二指肠切除术 (PD) 后的发病率在过去十年中保持不变。胃排空延迟 (DGE) 是一个主要因素,对医疗保健成本、生活质量以及对恶性肿瘤甚至生存产生重大影响。我们试图开发一种评分系统,以帮助在术前轻松识别有 DGE 风险的患者。

方法

从 2014 年到 2018 年的 ACS-NSQIP 数据集被查询为接受 Whipple 或保留幽门重建的 PD 患者。使用多变量逻辑回归分析了 15,154 名患者,以确定 DGE 的危险因素,并将其纳入预测模型。对没有 SSI 或瘘管(原发性 DGE)的患者进行亚组分析。

结果

我们确定了与 DGE 独立相关的 9 个因素来编制PrEDICT -DGE评分:程序(同时进行粘连松解术、空肠造口术、静脉移植血管重建)、老年人(年龄>70 岁)、导管支架(缺乏胆管支架)、内陷(胰腺重建技术)、COPD 烟草使用疾病、全身性(ASA>2)、性别(男性)和红细胞(术前红细胞输注)。PrEDICT-DGE评分与实际 DGE 率密切相关(R 2 = 0.95) 并预测患者处于低、中和高风险。

对原发性 DGE 患者的亚组分析保留了所有预测因素,但年龄>70 (p = 0.07) 和 ASA (p = 0.30) 除外。

结论

PrEDICT-DGE评分可准确识别 DGE 高危患者,并有助于指导围手术期管理。

更新日期:2021-06-24
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