Postoperative Proton Pump Inhibitors are associated with a significantly higher rate of delayed gastric emptying after pancreatoduodenectomy

Background: Proton pump inhibitors (PPIs) are effective in reducing marginal ulcers after pancreato-duodenectomy. However, their impact on perioperative complications has not been defined. Methods: We retrospectively analyzed the effect of postoperative PPIs on 90-day perioperative out-comes in all patients who underwent pancreatoduodenectomy at our institution from April 2017 to December 2020.Results: 284 patients were included; 206 (72.5%) received perioperative PPIs, 78 (27.5%) did not. The two cohorts were similar in demographics and operative variables. Postoperatively, the PPI cohort had significantly higher rates of overall complications (74.3% vs. 53.8%) and delayed gastric emptying (28.6% vs. 11.5%), p < 0.05. However, no differences in infectious complications, postoperative pancreatic fistula, or anastomotic leaks were seen. On multivariate analysis, PPI was independently associated with a higher risk of overall complications (OR 2.46, CI 1.33-4.54) and delayed gastric emptying (OR 2.73, CI 1.26-5.91), p = 0.011. Four patients developed marginal ulcers within 90-days postoperatively; all were in the group who received PPIs.Conclusion: Postoperative proton pump inhibitor use was associated with a significantly higher rate of overall complications and delayed gastric emptying after pancreatoduodenectomy.

Automated summary

A retrospective analysis found that postoperative use of proton pump inhibitors (PPIs) after pancreatoduodenectomy is associated with an increased risk of overall complications and delayed gastric emptying, but does not affect infectious complications, postoperative pancreatic fistula, or anastomotic leaks. All cases of marginal ulcers occurred in the PPI-treated group.