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Associations Between Patient Characteristics and Whipple Procedure Outcomes Before and After Implementation of an Enhanced Recovery After Surgery Protocol

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Purpose

The Enhanced Recovery After Surgery (ERAS) protocol is a multimodal perioperative care bundle aimed to improve pancreatic surgery outcomes. This work evaluates whether a Whipple ERAS protocol can be safely implemented at a quaternary care center. We also aimed to assess if race and socioeconomic factors are associated with disparities in outcomes in patients undergoing a Whipple ERAS protocol.

Methods

A retrospective review identified demographic and clinical data for 458 patients undergoing pancreaticoduodenectomies (PDs) at a single institution from October 2017 to May 2022. Patients were split into two cohorts: pre-ERAS (treated before implementation) and ERAS (treated after). Outcomes included length of stay (LOS), 30-day readmission and mortality rates, and major complications.

Results

There were 213 pre-ERAS PD patients, and 245 were managed with an ERAS protocol. More ERAS patients had a BMI > 30 (15.5% vs. 8.0%; p = 0.01) and received neoadjuvant chemotherapy (15.5% vs. 4.2%; p < 0.001). ERAS patients had a higher rate of major complications (57.6% vs. 37.6%; p < 0.001). Medicaid patients did not have more complications or longer LOS compared to non-Medicaid patients. On univariate analysis, race/ethnicity or gender was not significantly associated with a higher rate of major complications or prolonged LOS.

Conclusion

A Whipple ERAS protocol did not significantly change LOS, readmissions, or 30-day mortality. Rate of overall complications did not significantly change after implementation, but rate of major complications increased. These outcomes were not significantly impacted by race/ethnicity, gender, tumor staging, or insurance status.

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Acknowledgements

The authors acknowledge Vilma Rosario, the research coordinator for the Columbia University Division of GI/Endocrine Surgery, for her assistance with this study.

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Authors and Affiliations

  1. Division of GI/Endocrine Surgery, Department of Surgery, Columbia University Irving Medical Center, 161 Fort Washington Avenue, New York, NY, 10032, USA

    Anna S. Koerner, Alexander S. Thomas, John A. Chabot, Michael D. Kluger, Kazuki N. Sugahara & Beth A. Schrope

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  1. Anna S. Koerner
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Contributions

AK: protocol/project development, data collection/management, data analysis, manuscript writing/editing

AT: protocol/project development, data collection/management, data analysis, manuscript writing/editing

JC, MK, KS: protocol/project development, data collection/management

BS: protocol/project development, data collection/management, manuscript writing/editing

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Correspondence to Anna S. Koerner.

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This study was approved by the Columbia Institutional Review Board (IRB-AAAD4969).

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Koerner, A.S., Thomas, A.S., Chabot, J.A. et al. Associations Between Patient Characteristics and Whipple Procedure Outcomes Before and After Implementation of an Enhanced Recovery After Surgery Protocol. J Gastrointest Surg 27, 1855–1866 (2023). https://doi.org/10.1007/s11605-023-05693-x

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