Impact of feeding strategy after pancreatoduodenectomy on delayed gastric emptying and hospital stay: Nationwide study

Tessa E. Hendriks; Bo T.M. Strijbos; Michiel F.G. Francken; Mahsoem Ali; J. Annelie Suurmeijer; Marcel G.W. Dijkgraaf; Jana S. Hopstaken; Kees Van Laarhoven; Quintus Molenaar; Vincent E. De Meijer; Erwin Van Der Harst; Marcel Den Dulk; Werner Draaisma; Vincent Nieuwenhuijs; Michael F. Gerhards; Mike S.L. Liem; George Van Der Schelling; Eric Manusama; Ignace De Hingh; Hjalmar Van Santvoort; Bas Groot Koerkamp; Olivier R. Busch; Bert A. Bonsing; Martijn W.J. Stommel; Marc G. Besselink; J. Haver; E. Steenhagen

doi:10.1093/bjsopen/zraf068

Impact of feeding strategy after pancreatoduodenectomy on delayed gastric emptying and hospital stay: Nationwide study

Tessa E. Hendriks
, Bo T.M. Strijbos
, Michiel F.G. Francken
, Mahsoem Ali
, J. Annelie Suurmeijer
, Marcel G.W. Dijkgraaf
, Jana S. Hopstaken
, Kees Van Laarhoven
, Quintus Molenaar
, Vincent E. De Meijer
, Erwin Van Der Harst
, Marcel Den Dulk
, Werner Draaisma
, Vincent Nieuwenhuijs
, Michael F. Gerhards
, Mike S.L. Liem
, George Van Der Schelling
, Eric Manusama
, Ignace De Hingh
, Hjalmar Van Santvoort

Bas Groot Koerkamp, Olivier R. Busch, Bert A. Bonsing, Martijn W.J. Stommel, Marc G. Besselink^*, J. Haver, E. Steenhagen

^*Corresponding author for this work

Surgery

Amsterdam UMC
Cancer Center Amsterdam (CCA)
Leiden University Medical Centre
Dutch Institute for Clinical Auditing (DICA)
Radboud University Medical Center
University of Amsterdam
Utrecht University
University of Groningen
University Medical Centre Groningen
Maasstad Hospital
Maastricht University
Jeroen Bosch Ziekenhuis
Isala Clinics
Onze Lieve Vrouwe Gasthuis
Medisch Spectrum Twente
Amphia Hospital
Medisch Centrum Leeuwarden
Catharina Hospital
Leiden University

Research output: Contribution to journal › Article › Academic › peer-review

1 Citation (Scopus)

37 Downloads (Pure)

Abstract

Background:

Delayed gastric emptying is a major contributor to prolonged hospital stay following pancreatoduodenectomy. Although enhanced recovery after surgery guidelines recommend unrestricted feeding after pancreatoduodenectomy, nationwide studies evaluating the impact of different feeding strategies after surgery on delayed gastric emptying and length of hospital stay are limited. This study aimed to identify the use and impact of different feeding strategies after pancreatoduodenectomy on delayed gastric emptying and length of hospital stay.

Methods:

This nationwide cohort study included consecutive patients after pancreatoduodenectomy from the Dutch Pancreatic Cancer Audit (2021-2023). Primary endpoints were delayed gastric emptying grade B/C and length of hospital stay. Feeding strategies were categorized based on structured interviews with representatives from 15 centres. Multilevel analysis was used to assess associations between feeding strategy, delayed gastric emptying, and length of hospital stay. Predictors of delayed gastric emptying were determined.

Results:

Overall, 2354 patients undergoing pancreatoduodenectomy were included, of whom 526 (23%) developed delayed gastric emptying grade B/C. Median length of hospital stay was 13 days longer in patients with delayed gastric emptying (23 versus 10 days; P < 0.001). Feeding strategies were: unrestricted feeding (3 centres, 637 patients; delayed gastric emptying 18%); step-up feeding (9 centres, 1462 patients; delayed gastric emptying 24%); and artificial feeding (3 centres, 255 patients; delayed gastric emptying 25%). No association was observed between feeding strategy and delayed gastric emptying: step-up versus unrestricted feeding (odds ratio 1.14, 95% confidence interval 0.53 to 2.47) and artificial versus unrestricted feeding (odds ratio 1.76, 0.65 to 4.73). Similarly, no association was found between feeding strategy and length of hospital stay. The strongest predictor of delayed gastric emptying was pancreatic fistula after surgery (odds ratio 3.16, 2.47 to 4.05).

Conclusion:

This study found no significant association between feeding strategy and incidence of delayed gastric emptying or length of hospital stay after pancreatoduodenectomy. Efforts to reduce delayed gastric emptying should focus on reducing pancreatic fistula after surgery.

Original language	English
Article number	zraf068
Journal	BJS open
Volume	9
Issue number	3
DOIs	https://doi.org/10.1093/bjsopen/zraf068
Publication status	Published - Jun 2025

Bibliographical note

Publisher Copyright:
© 2025 The Author(s). Published by Oxford University Press on behalf of BJS Foundation Ltd.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

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Impact of feeding strategy after pancreatoduodenectomy on delayed gastric emptying and hospital stayFinal published version, 429 KBLicence: CC BY

Cite this

Hendriks, T. E., Strijbos, B. T. M., Francken, M. F. G., Ali, M., Suurmeijer, J. A., Dijkgraaf, M. G. W., Hopstaken, J. S., Van Laarhoven, K., Molenaar, Q., De Meijer, V. E., Van Der Harst, E., Den Dulk, M., Draaisma, W., Nieuwenhuijs, V., Gerhards, M. F., Liem, M. S. L., Van Der Schelling, G., Manusama, E., De Hingh, I., ... Steenhagen, E. (2025). Impact of feeding strategy after pancreatoduodenectomy on delayed gastric emptying and hospital stay: Nationwide study. BJS open, 9(3), Article zraf068. https://doi.org/10.1093/bjsopen/zraf068

@article{95832933d44c462288954b483d94f14b,

title = "Impact of feeding strategy after pancreatoduodenectomy on delayed gastric emptying and hospital stay: Nationwide study",

abstract = "Background:Delayed gastric emptying is a major contributor to prolonged hospital stay following pancreatoduodenectomy. Although enhanced recovery after surgery guidelines recommend unrestricted feeding after pancreatoduodenectomy, nationwide studies evaluating the impact of different feeding strategies after surgery on delayed gastric emptying and length of hospital stay are limited. This study aimed to identify the use and impact of different feeding strategies after pancreatoduodenectomy on delayed gastric emptying and length of hospital stay. Methods: This nationwide cohort study included consecutive patients after pancreatoduodenectomy from the Dutch Pancreatic Cancer Audit (2021-2023). Primary endpoints were delayed gastric emptying grade B/C and length of hospital stay. Feeding strategies were categorized based on structured interviews with representatives from 15 centres. Multilevel analysis was used to assess associations between feeding strategy, delayed gastric emptying, and length of hospital stay. Predictors of delayed gastric emptying were determined. Results: Overall, 2354 patients undergoing pancreatoduodenectomy were included, of whom 526 (23\%) developed delayed gastric emptying grade B/C. Median length of hospital stay was 13 days longer in patients with delayed gastric emptying (23 versus 10 days; P < 0.001). Feeding strategies were: unrestricted feeding (3 centres, 637 patients; delayed gastric emptying 18\%); step-up feeding (9 centres, 1462 patients; delayed gastric emptying 24\%); and artificial feeding (3 centres, 255 patients; delayed gastric emptying 25\%). No association was observed between feeding strategy and delayed gastric emptying: step-up versus unrestricted feeding (odds ratio 1.14, 95\% confidence interval 0.53 to 2.47) and artificial versus unrestricted feeding (odds ratio 1.76, 0.65 to 4.73). Similarly, no association was found between feeding strategy and length of hospital stay. The strongest predictor of delayed gastric emptying was pancreatic fistula after surgery (odds ratio 3.16, 2.47 to 4.05). Conclusion: This study found no significant association between feeding strategy and incidence of delayed gastric emptying or length of hospital stay after pancreatoduodenectomy. Efforts to reduce delayed gastric emptying should focus on reducing pancreatic fistula after surgery.",

author = "Hendriks, \{Tessa E.\} and Strijbos, \{Bo T.M.\} and Francken, \{Michiel F.G.\} and Mahsoem Ali and Suurmeijer, \{J. Annelie\} and Dijkgraaf, \{Marcel G.W.\} and Hopstaken, \{Jana S.\} and \{Van Laarhoven\}, Kees and Quintus Molenaar and \{De Meijer\}, \{Vincent E.\} and \{Van Der Harst\}, Erwin and \{Den Dulk\}, Marcel and Werner Draaisma and Vincent Nieuwenhuijs and Gerhards, \{Michael F.\} and Liem, \{Mike S.L.\} and \{Van Der Schelling\}, George and Eric Manusama and \{De Hingh\}, Ignace and \{Van Santvoort\}, Hjalmar and \{Groot Koerkamp\}, Bas and Busch, \{Olivier R.\} and Bonsing, \{Bert A.\} and Stommel, \{Martijn W.J.\} and Besselink, \{Marc G.\} and J. Haver and E. Steenhagen",

note = "Publisher Copyright: {\textcopyright} 2025 The Author(s). Published by Oxford University Press on behalf of BJS Foundation Ltd.",

year = "2025",

month = jun,

doi = "10.1093/bjsopen/zraf068",

language = "English",

volume = "9",

journal = "BJS open",

issn = "2474-9842",

publisher = "Oxford University Press",

number = "3",

}

Hendriks, TE, Strijbos, BTM, Francken, MFG, Ali, M, Suurmeijer, JA, Dijkgraaf, MGW, Hopstaken, JS, Van Laarhoven, K, Molenaar, Q, De Meijer, VE, Van Der Harst, E, Den Dulk, M, Draaisma, W, Nieuwenhuijs, V, Gerhards, MF, Liem, MSL, Van Der Schelling, G, Manusama, E, De Hingh, I, Van Santvoort, H, Groot Koerkamp, B, Busch, OR, Bonsing, BA, Stommel, MWJ, Besselink, MG, Haver, J & Steenhagen, E 2025, 'Impact of feeding strategy after pancreatoduodenectomy on delayed gastric emptying and hospital stay: Nationwide study', BJS open, vol. 9, no. 3, zraf068. https://doi.org/10.1093/bjsopen/zraf068

TY - JOUR

T1 - Impact of feeding strategy after pancreatoduodenectomy on delayed gastric emptying and hospital stay

T2 - Nationwide study

AU - Hendriks, Tessa E.

AU - Strijbos, Bo T.M.

AU - Francken, Michiel F.G.

AU - Ali, Mahsoem

AU - Suurmeijer, J. Annelie

AU - Dijkgraaf, Marcel G.W.

AU - Hopstaken, Jana S.

AU - Van Laarhoven, Kees

AU - Molenaar, Quintus

AU - De Meijer, Vincent E.

AU - Van Der Harst, Erwin

AU - Den Dulk, Marcel

AU - Draaisma, Werner

AU - Nieuwenhuijs, Vincent

AU - Gerhards, Michael F.

AU - Liem, Mike S.L.

AU - Van Der Schelling, George

AU - Manusama, Eric

AU - De Hingh, Ignace

AU - Van Santvoort, Hjalmar

AU - Groot Koerkamp, Bas

AU - Busch, Olivier R.

AU - Bonsing, Bert A.

AU - Stommel, Martijn W.J.

AU - Besselink, Marc G.

AU - Haver, J.

AU - Steenhagen, E.

PY - 2025/6

Y1 - 2025/6

N2 - Background:Delayed gastric emptying is a major contributor to prolonged hospital stay following pancreatoduodenectomy. Although enhanced recovery after surgery guidelines recommend unrestricted feeding after pancreatoduodenectomy, nationwide studies evaluating the impact of different feeding strategies after surgery on delayed gastric emptying and length of hospital stay are limited. This study aimed to identify the use and impact of different feeding strategies after pancreatoduodenectomy on delayed gastric emptying and length of hospital stay. Methods: This nationwide cohort study included consecutive patients after pancreatoduodenectomy from the Dutch Pancreatic Cancer Audit (2021-2023). Primary endpoints were delayed gastric emptying grade B/C and length of hospital stay. Feeding strategies were categorized based on structured interviews with representatives from 15 centres. Multilevel analysis was used to assess associations between feeding strategy, delayed gastric emptying, and length of hospital stay. Predictors of delayed gastric emptying were determined. Results: Overall, 2354 patients undergoing pancreatoduodenectomy were included, of whom 526 (23%) developed delayed gastric emptying grade B/C. Median length of hospital stay was 13 days longer in patients with delayed gastric emptying (23 versus 10 days; P < 0.001). Feeding strategies were: unrestricted feeding (3 centres, 637 patients; delayed gastric emptying 18%); step-up feeding (9 centres, 1462 patients; delayed gastric emptying 24%); and artificial feeding (3 centres, 255 patients; delayed gastric emptying 25%). No association was observed between feeding strategy and delayed gastric emptying: step-up versus unrestricted feeding (odds ratio 1.14, 95% confidence interval 0.53 to 2.47) and artificial versus unrestricted feeding (odds ratio 1.76, 0.65 to 4.73). Similarly, no association was found between feeding strategy and length of hospital stay. The strongest predictor of delayed gastric emptying was pancreatic fistula after surgery (odds ratio 3.16, 2.47 to 4.05). Conclusion: This study found no significant association between feeding strategy and incidence of delayed gastric emptying or length of hospital stay after pancreatoduodenectomy. Efforts to reduce delayed gastric emptying should focus on reducing pancreatic fistula after surgery.

AB - Background:Delayed gastric emptying is a major contributor to prolonged hospital stay following pancreatoduodenectomy. Although enhanced recovery after surgery guidelines recommend unrestricted feeding after pancreatoduodenectomy, nationwide studies evaluating the impact of different feeding strategies after surgery on delayed gastric emptying and length of hospital stay are limited. This study aimed to identify the use and impact of different feeding strategies after pancreatoduodenectomy on delayed gastric emptying and length of hospital stay. Methods: This nationwide cohort study included consecutive patients after pancreatoduodenectomy from the Dutch Pancreatic Cancer Audit (2021-2023). Primary endpoints were delayed gastric emptying grade B/C and length of hospital stay. Feeding strategies were categorized based on structured interviews with representatives from 15 centres. Multilevel analysis was used to assess associations between feeding strategy, delayed gastric emptying, and length of hospital stay. Predictors of delayed gastric emptying were determined. Results: Overall, 2354 patients undergoing pancreatoduodenectomy were included, of whom 526 (23%) developed delayed gastric emptying grade B/C. Median length of hospital stay was 13 days longer in patients with delayed gastric emptying (23 versus 10 days; P < 0.001). Feeding strategies were: unrestricted feeding (3 centres, 637 patients; delayed gastric emptying 18%); step-up feeding (9 centres, 1462 patients; delayed gastric emptying 24%); and artificial feeding (3 centres, 255 patients; delayed gastric emptying 25%). No association was observed between feeding strategy and delayed gastric emptying: step-up versus unrestricted feeding (odds ratio 1.14, 95% confidence interval 0.53 to 2.47) and artificial versus unrestricted feeding (odds ratio 1.76, 0.65 to 4.73). Similarly, no association was found between feeding strategy and length of hospital stay. The strongest predictor of delayed gastric emptying was pancreatic fistula after surgery (odds ratio 3.16, 2.47 to 4.05). Conclusion: This study found no significant association between feeding strategy and incidence of delayed gastric emptying or length of hospital stay after pancreatoduodenectomy. Efforts to reduce delayed gastric emptying should focus on reducing pancreatic fistula after surgery.

UR - https://www.scopus.com/pages/publications/105008382247

U2 - 10.1093/bjsopen/zraf068

DO - 10.1093/bjsopen/zraf068

M3 - Article

C2 - 40512076

AN - SCOPUS:105008382247

SN - 2474-9842

VL - 9

JO - BJS open

JF - BJS open

IS - 3

M1 - zraf068

ER -

Impact of feeding strategy after pancreatoduodenectomy on delayed gastric emptying and hospital stay: Nationwide study

Abstract

Bibliographical note

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