Feeding Tube Placement in Nutritionally At-risk Patients Undergoing Pancreaticoduodenectomy: A Propensity...

Routine feeding tube (FT) placement during pancreaticoduodenectomy (PD) has not reduced complication rates. Nonetheless, FTs are often selectively placed in patients with poor nutritional status such as those with significant weight loss or hypoalbuminemia, based on the assumption that the benefits outweigh the risks. This study examined whether FT placement reduced complications in at-risk nutritional subgroups.

This retrospective cohort study used data from the National Surgical Quality Improvement Program (NSQIP) database (2017-2020). Patients undergoing PD were grouped according to nutritional status as follows: (1) weight Loss >10%, (2) albumin <30 g/L, (3) weight loss or low albumin, (4) both weight loss and low albumin, and (5) neither. Five propensity score matching (PSM) models were utilized, each adjusted for perioperative variables, and postoperative outcomes between patients with and without FTs across these groups were compared. Each subgroup analysis served as an independent evaluation of the potential benefits of FT placement in the defined populations.

Among 16,780 patients with PD, 742 (4.4%) received FTs. PSM analyses showed that FT placement did not reduce complications in any subgroup, but significantly increased delayed gastric emptying rates, especially in patients with low albumin and weight loss (29.4% vs 16.0%, P < 0.0001). FT placement also led to longer hospital stays (11 vs 8 d, P < 0.0001) and higher reoperation rates in 2 groups.

In nutritionally at-risk patients undergoing pancreaticoduodenectomy, the risks of feeding tube placement appear to outweigh the benefits, as no reduction in complications was observed, and morbidity was increased.