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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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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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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DOI: https://doi.org/10.1007/s11605-023-05693-x