Pancreaticoduodenectomy (PD) is a complex abdominal procedure with high rates of perioperative morbidity. The Whipple Accelerated Recovery Pathway (WARP) was developed for highly selected patients undergoing PD to reduce hospital length of stay (LOS) and time to adjuvant therapy (TTAT), without increasing post-operative complications (POC) or readmission rates (RR). The purpose of this study was to determine if WARP could be implemented for all-risk patients undergoing PD.
A single-institution, retrospective analysis of 281 patients implemented on the WARP between 2017-2020 was performed. 119 patients were categorized as WARP-eligible (WEPs) according to original inclusion criteria, and 162 were deemed WARP-ineligible (WIPs). Primary endpoints include LOS, TTAT, RR, and POC. Data was collected from Epic and a multivariate analysis with logistic regression was performed.
28 POC were found in WEPs (23.5%) compared to 73 POC in WIPs (45.1%) (p<0.05). Delayed gastric emptying (DGE) and post-operative pancreatic fistulas (POPF) were higher in WIPs: DGE was found in 10.2% of WEPs vs. 26.2% of WIPs (p<0.05), while POPF was found in 5.1% of WEPs vs. 21% of WIPs (p<0.05). Mean LOS was 5 days for WEPs vs. 6 days for WIPs (p<0.05). TTAT was 55 days for WEPs, compared to 63 days in WIPs (p<0.05). RR was 12.6% for WEPs and 23.5% for WIPs (p<0.05).
WARP results in lowered POC, TTAT, LOS, and RR, cutting costs to patients. WARP may be expanded to all PD patients; however, WIPs may benefit from additional modifications that are specific for patient risk factors
Kavanagh, Taylor R.; Yudkoff, Clifford; Torjani, Ava; Krampitz, Geoffrey W.; Bowne, Wilbur; Rshaidat, Hamza; Sholevar, Cyrus J.; Leto, Alexandra C.; Preston, William; Tham, Elwin; Shergill, Mandeep; Cannaday, Shawnna; Yeo, Theresa; Lavu, Harish; and Yeo, Charles J., "Expanding the Whipple Accelerated Recovery Pathway (WARP) To All Patients Undergoing Pancreaticoduodenectomy (PD)" (2021). Phase 1. Paper 9.