Correlation between the initiation of early enteral nutrition and anastomotic fistula after pancreaticoduodenectomy

Table 1 Comparison of baseline characteristics between the 2 groups, n (%)/mean ± SD

Characteristic	Group		χ2/t	P value
	Study (n = 100)	Control (n = 100)
Age, years	52.36 ± 8.72	53.18 ± 9.21	0.647	0.519
Sex (male/female)	58/42	61/39	0.187	0.666
Body mass index, kg/m2	23.57 ± 2.82	23.85 ± 3.19	0.658	0.512
Diabetes mellitus	28 (28.00)	32 (32.00)	0.381	0.537
Hypertension	35 (35.00)	38 (38.00)	0.194	0.660
Primary diagnosis			1.241	0.743
Carcinoma of head of pancreas	52 (52.00)	55 (55.00)
Ampullary carcinoma	25 (25.00)	22 (22.00)
Distal cholangiocarcinoma	15 (15.00)	18 (18.00)
Others	8 (8.00)	5 (5.00)
Operative procedure			0.500	0.480
Child method	78 (78.00)	82 (82.00)
Whipple procedure	22 (22.00)	18 (18.00)
Operative duration, minute	320.54 ± 55.27	325.84 ± 60.13	0.649	0.517
Intraoperative blood loss, mL	450.21 ± 80.58	465.33 ± 95.78	1.208	0.228
Pancreatic texture			0.325	0.569
Soft	42 (42.00)	46 (46.00)
Firm	58 (58.00)	54 (54.00)
Main pancreatic duct diameter, mm			0.202	0.653
≥ 3	65 (65.00)	68 (68.00)
< 3	35 (35.00)	32 (32.00)

Table 2 Comparison of nutritional indicators: Preoperative (before) vs postoperative day 7 (after), mean ± SD

Group	n	ALB (g/L)		Pre-ALB (mg/L)		TF (g/L)
		Before	After	Before	After	Before	After
Study	100	38.28 ± 4.10	37.80 ± 3.87	220.53 ± 55.32	215.68 ± 51.37	2.48 ± 0.43	2.43 ± 0.39
Control	100	37.85 ± 4.54	32.57 ± 3.76	215.86 ± 58.72	187.69 ± 50.12	2.46 ± 0.38	1.97 ± 0.45
t		0.703	9.693	0.579	3.900	0.349	7.725
P value		0.483	0.000	0.563	0.000	0.728	0.000

ALB: Albumin; Pre-ALB: Prealbumin; TF: Transferrin.

Table 3 Comparison of gastrointestinal function recovery time and postoperative length of stay, mean ± SD

Index	Study group (n = 100)	Control group (n = 100)	t	P value
Return of bowel sounds, hour	38.56 ± 12.32	62.88 ± 18.73	10.848	< 0.001
Time to first flatus, hour	48.21 ± 15.65	78.56 ± 22.48	11.080	< 0.001
Time to first defecation, hour	72.43 ± 20.10	105.38 ± 28.95	9.349	< 0.001
Postoperative hospital stay, days	14.25 ± 3.83	18.77 ± 5.24	6.964	< 0.001

Table 4 Comparison of anastomotic leakage between the 2 groups, n (%)

Type of AL	Study (n = 100)	Control (n = 100)	χ2	P value	OR (95%CI)
Overall AL	18 (18.00)	32 (32.00)	5.227	0.022	0.467 (0.241-0.904)
Pancreatic fistula (grade B/C)	12 (12.00)	25 (25.00)	5.604	0.018	0.409 (0.192-0.870)
Bile leak	6 (6.00)	9 (9.00)	0.617	0.432	0.652 (0.223-1.907)
Gastroenteric AL	3 (3.00)	6 (6.00)	-	0.498a	0.500 (0.129-1.950)
≥ 2 concurrent fistulas	2 (2.00)	5 (5.00)	-	0.445a	0.400 (0.079-2.014)

^aP < 0.05, the study group vs the control group.

AL: Anastomotic leakage; OR: Odds ratio; CI: Confidence interval.

Table 5 Binary logistic regression analysis of risk-factors for anastomotic leakage

Variable	β coefficient	SE	χ2	P value	OR (95%CI)
Early enteral nutrition	-0.868	0.362	5.75	0.016	0.419 (0.210-0.850)
Age, years	0.028	0.018	2.418	0.120	1.028 (0.993-1.065)
Sex	-0.204	0.351	0.339	0.561	0.815 (0.412-1.618)
Body mass index, kg/m2	-0.041	0.062	0.439	0.507	0.959 (0.851-1.078)
History of diabetes	0.387	0.378	1.050	0.307	1.472 (0.703-3.088)
Soft pancreatic texture	1.055	0.361	8.539	0.003	2.871 (1.420-5.810)
Pancreatic duct < 3 mm	0.854	0.359	5.659	0.015	2.348 (1.180-4.670)
Operative duration, minute	0.008	0.003	7.111	0.008	1.008 (1.002-1.014)
Intraoperative blood loss, mL	0.002	0.001	4.000	0.134	1.002 (1.000-1.004)

OR: Odds ratio; CI: Confidence interval.