The Perioperative Management of Patients Presenting for Whipple’s Procedure at an Academic Institution

Abstract Background The Whipple’s procedure or pancreaticoduodenectomy is the primary treatment method of pancreatic cancer and more recently for other benign and cancerous lesions of the periampullary region. The procedure has associated with high mortality and morbidity rates since its inception but with improving surgical techniques and peri-operative care, these have improved over the decades. Our aims were to describe perioperative patient demographic profile, surgical indications, intra-operative surgical and anaesthetic techniques for Whipple’s procedure and their impact on patient outcomes in our centre. Methods A review of patients database over a 10-year period (01 January 2012 to 31 December 2022) at Charlotte Maxeke Johannesburg Academic Hospital was performed. The data was collected using a RedCap® collection tool developed by the researchers based on previous studies. The patient profile, preoperative clinical presentations, surgical indications, intra-operative surgical findings and intraoperative anaesthetic techniques were collected. Post operative data on length of intensive care unit stay, hospital stay, morbidity and mortality were also collected. Data was analysed using the Statistical Product and Services Solutionsystem. Results A total of 50 Whipple’s procedures were performed over the 10-year period, with the male gender at 58% and overall median patient age of 53 years. The main presenting symptom was jaundice with major surgical indication in this cohort being head of pancreas mass. Open procedure dominated surgical technique with an average surgical time of 552 minutes. All procedures were done under general anaesthesia and neuraxial analgesic technique favoured in addition to intravenous analgesics. Post-operatively, average length of ICU stay was 5.4 days and average length of hospital stay was 17 days. Intra-abdominal collection was the most observed complication. Liberal crystalloids use was associated with significantly longer ICU stays (p-value = 0.009) and bile leak. Blood transfusions were associated with wound sepsis and development of acute kidney injury. Mortality rate was 26%. Conclusions The lower volume of Whipple’s procedures performed yearly at CMJAH may be the reason for the observed higher mortality and morbidity rates than those seen in developed countries. In keeping with current literature, liberal crystalloids and blood transfusions were associated with post-operative complications.