Preoperative anxiety state is an independent risk factor for delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy: a single-center retrospective case-control study

Delayed gastric emptying (DGE) is one of the prevalent complications following pylorus-preserving pancreaticoduodenectomy (PPPD). Anxiety is one of the common psychological comorbidities among tumor patients. However, its influence on the development of DGE post-PPPD remains elusive. Thus, this study aimed to explore the relationship between anxiety states and the incidence of DGE after PPPD. This single-center, retrospective case-control study enrolled 150 patients who underwent PPPD between January 2020 and December 2022. Preoperative anxiety state was assessed using the Hamilton Anxiety Scale (HAMA), and patients were stratified into two groups based on the presence or absence of DGE. Lastly, risk factors for DGE were analyzed based on clinical data, laboratory indicators, postoperative complications, and other indicators. The incidence of postoperative DGE was 28.67%. Patients who developed DGE had significantly higher body mass index (BMI) (23.50 ± 3.85 vs 22.20 ± 2.39, <i>p</i> = 0.013), a higher prevalence of hypertension (46.51% vs 28.97%, <i>p</i> = 0.040) and anxiety state (72.09% vs 48.60%, <i>p</i> = 0.009), as well as high preoperative blood lipid levels [1.87 (1.30, 2.36) vs 1.39 (0.96, 2.02), <i>p</i> = 0.005] may increase the occurrence of DGE. In contrast, high albumin levels on the third day postoperatively (33.18 ± 4.31 vs 35.23 ± 3.47, <i>p</i> = 0.003) conferred protective effects against DGE. Anxiety state (OR: 2.605, 95%CI: 1.170–6.138, <i>p</i> = 0.019) and high BMI (OR: 1.157, 95%CI: 1.022–1.332, <i>p</i> = 0.021) were identified as independent risk factors for DGE. After propensity score matching, anxiety state (<i>p</i> = 0.042) remained an independent risk factor for DGE. Anxiety state, BMI, hypertension, preoperative blood lipid levels, and albumin level on the third day after surgery were related to the occurrence of DGE after PPPD. Among them, anxiety state was identified as an independent risk factor for DGE. These findings highlight the need for implementing timely and appropriate psychological interventions in patients undergoing PPPD to minimize the risk of postoperative DGE. ClinicalTrials.gov Identifier: ChiCTR2400090370.