Effect of the enhanced recovery after surgery (ERAS®) program on postoperative complications in the Whipple operation: A prospective cohort

Jamshed Alam; Yousaf Jan; Musarrat Hussain; Muhib Ullah; Muhammad Jawad Zahid

doi:10.53730/ijhs.v6nS10.14010

Authors

Jamshed Alam 1. Associate Professor Department of Surgery Hayatabad Medical Complex Peshawar, Pakistan
Yousaf Jan
dr.yousaf.shinwari@gmail.com
2. Assistant Professor Department of Surgery Hayatabad Medical Complex Peshawar, Pakistan
Musarrat Hussain 3. Assistant Professor Department of Surgery Hayatabad Medical Complex Peshawar, Pakistan
Muhib Ullah 4. Senior Registrar Department of Surgery Hayatabad Medical Complex Peshawar, Pakistan
Muhammad Jawad Zahid 5. Resident Department of Surgery Hayatabad Medical Complex Peshawar, Pakistan

Keywords:

Whipple procedure, ERAS, pancreatectomy

Abstract

Background: The Whipple operation treats pancreatic, bile duct, and intestinal malignancies. ERAS® usage in the Whipple surgery is seldom documented. So, this study examined how the ERAS® regimen affected postoperative complications in Whipple patients. Method: From January 2017 to December 2022, 97 patients were admitted to the general surgery department at Hayatabad Medical Complex, Peshawar, Pakistan, a tertiary care hospital. This study recruited Whipple patients. The prospective group was treated with ERAS methods, whereas the control group was handled using the non-ERAS treatment (Jan 2017–Dec 2018). The Whipple technique was performed on 18-year-olds with pancreatic, duodenum, and bile duct cancer. The present study's primary outcomes were CDC grading, surgical complications, 30-day readmission rate, 30-day re-operation for any reason, and hospital stay. SPSS 26.0 examined data. Results: This study has 97 patients. Both groups had equal comorbidities. The ERAS® technique minimized postoperative complications, as seen by the considerable drop in CDC grading (p = 0.003). Non-ERAS® patients had increased mortality (2 vs. 8). ERAS® also decreased stay duration (p = 0.001). ERAS® patients also had a lower readmission rate (p = 0.001). Conclusion: The Whipple procedure's ERAS® protocol has lowered postoperative complications, duration of stay, and readmission rates.

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References

Cai, J., et al., Advances in the epidemiology of pancreatic cancer: Trends, risk factors, screening, and prognosis. Cancer Lett, 2021. 520: p. 1-11.

Ilic, M. and I. Ilic, Epidemiology of pancreatic cancer. World J Gastroenterol, 2016. 22(44): p. 9694-9705.

Ren, B. et al., Tumor microenvironment participates in pancreatic cancer metastasis. Mol Cancer, 2018. 17(1): p. 108.

Reyna-Sepúlveda, F., et al., Prognostic factors for survival and surgical complications in Whipple's pancreatoduodenectomy during a 10-year experience. Cir Cir, 2019. 87(2): p. 205-210.

Torphy, R.J., Y. Fujiwara, and R.D. Schulick, Pancreatic cancer treatment is better, but a long way to go. Surg Today, 2020. 50(10): p. 1117-1125.

Cisco, R.M. and J.A. Norton, Surgery for gastrinoma. Adv Surg, 2007. 41: p. 165-76.

Fernández-del Castillo, C., et al., Evolution of the Whipple procedure at the Massachusetts General Hospital. Surgery, 2012. 152(3 Suppl 1): p. S56-63.

Standup, J., et al., Emergency Kausch-Whipple procedure: indications and experiences. Pancreas, 2010. 39(2): p. 156-9.

Johnson, P.T., et al., Spiral CT following the Whipple procedure: distinguishing normal postoperative findings from complications. J Comput Assist Tomogr, 2002. 26(6): p. 956-61.

Karim, S.A.M., et al., The outcomes and complications of pancreaticoduodenectomy (Whipple procedure): Cross-sectional study. Int J Surg, 2018. 52: p. 383-387.

Simon, R., Complications After Pancreaticoduodenectomy. Surg Clin North Am, 2021. 101(5): p. 865-874.

Cavallaro, P. and L. Bordeianou, Implementation of an ERAS Pathway in Colorectal Surgery. Clin Colon Rectal Surg, 2019. 32(2): p. 102-108.

Gustafsson, U.O., et al., Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS(®)) Society Recommendations: 2018. World J Surg, 2019. 43(3): p. 659-695.

Pędziwiatr, M., et al., Current status of enhanced recovery after surgery (ERAS) protocol in gastrointestinal surgery. Med Oncol, 2018. 35(6): p. 95.

Ljungqvist, O., M. Scott, and K.C. Fearon, Enhanced Recovery After Surgery: A Review. JAMA Surg, 2017. 152(3): p. 292-298.

Noba, L. et al., Enhanced Recovery After Surgery (ERAS) Reduces Hospital Costs and Improve Clinical Outcomes in Liver Surgery: a Systematic Review and Meta-Analysis. J Gastrointest Surg, 2020. 24(4): p. 918-932.

Lobo, D.N. et al., Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomized controlled trial. Lancet, 2002. 359(9320): p. 1812-8.

Barbieri, A., et al., Effects of clinical pathways in the joint replacement: a meta-analysis. BMC Med, 2009. 7: p. 32.

Kagedan, D.J., et al., Enhanced recovery after pancreatic surgery: a systematic review of the evidence. HPB (Oxford), 2015. 17(1): p. 11-6.

Melloul, E., et al., Guidelines for Perioperative Care for Pancreatoduodenectomy: Enhanced Recovery After Surgery (ERAS) Recommendations 2019. World J Surg, 2020. 44(7): p. 2056-2084.

Ji, H.B., et al., Impact of enhanced recovery after surgery programs on pancreatic surgery: A meta- analysis. World J Gastroenterol, 2018. 24(15): p. 1666-1678.

St-Amour, P., et al., Impact of ERAS compliance on the delay between surgery and adjuvant chemotherapy in hepatobiliary and pancreatic malignancies. Langenbecks Arch Surg, 2020. 405(7): p. 959-966.

Pang, Q., et al., Oncologic and long-term outcomes of enhanced recovery after surgery in cancer surgeries - a systematic review. World J Surg Oncol, 2021. 19(1): p. 191.

Mathew G, Agha R; STROCSS Group. STROCSS 2021: Strengthening the reporting of the cohort, cross-sectional and case-control studies in surgery. Int J Surg. 2021 Dec;96:106165. doi: 10.1016/j.ijsu.2021.106165. Epub 2021 Nov 11. PMID: 34774726.