Establishment And Validation Of A Risk Predictive Model For Grade B/C Delayed Gastric Emptying After Pancreaticoduodenectomy

Objective: To investigate the risk factors of grade B/C delayed gastric emptying(DGE)after panereaticoduodenectomy(PD),establish a predictive model and validate its accuracy.To effectively screen out the high-risk patients and take preventive measures to reduce the incidence of grade B/C DGE after PD.Methods: The clinical data of patients underwent PD in our hospital from January 2013 to December 2017 were retrospectively analyzed.The eligible subjects were enrolled according the inclusion and exclusion criteria and randomly divided to the model group and validation group at a ratio of 3:1.The data of model group were subjected to univariate and multivariate logistic regression analysis,the independent risk factors of grade B/C DGE after PD were screened from twenty clinical factors.A risk predictive model was established,and the data of validation group were applied to validate its accuracy.Results: 420 patients enrolled this study including 315 of the model group and105 of the validation group.The overall incidence of grade B/C DGE was 14.8%(62/420).The multivariate analysis of the model group showed that diabetes mellitus(OR=4.39,95%CI:1.16-16.66,P=0.030),previous abdominal surgery(OR=2.99,95%CI:1.04-8.56,P=0.041),preoperative serum TBIL≥171umol/L(OR=4.11,95 %CI:1.72-9.83,P=0.001),the operation time≥6h(OR=8.88,95%CI:2.36-33.43,P=0.001)were independent risk factors of grade B/C DGE,but Braun anastomosis(OR=0.07,95 % CI:0.03-0.17,P=0.000),and early enteral nutrition(EEN)(OR=0.16,95%CI:0.04-0.67,P=0.013)were protective factors.A risk predictive model of grade B/C DGE after PD was established based on these risk factors.In the model group,the cut off point of Receiver Operating Characteristic curve(ROC)was 0.22.The sensitivity and specificity were 76.6% and 87.7%,respectively.The area under the curve(AUC)was 0.89(95%CI: 0.83-0.94).Regards to the validation group,the sensitivity and specificity were 73.3% and 85.6%,respectively.The AUC was 0.82(95%CI: 0.67-0.97),which suggested that the present risk predictive model has agood accuracy.Conclusions Diabetes mellitus,previous upper abdominal surgery,preoperative serum TBIL≥171umol/L and the operation time≥6h are independent risk factors,while Braun anastomosis and ENN are protective factors of grade B/C DGE after PD.The present risk predictive model has a good accuracy,and it is helpful for the prediction and prevention grade B/C DGE after PD.