Perioperative factors impacting intensive care outcomes following Whipple procedure: A retrospective study

R Udhayachandhar; J Otokwala; Pritish J Korula; Manbha Rymbai; Tony T Chandy; Philip Joseph

doi:10.4103/ija.IJA_727_19

Perioperative factors impacting intensive care outcomes following Whipple procedure: A retrospective study

Indian J Anaesth. 2020 Mar;64(3):216-221. doi: 10.4103/ija.IJA_727_19. Epub 2020 Mar 11.

Authors

R Udhayachandhar¹, J Otokwala², Pritish J Korula¹, Manbha Rymbai³, Tony T Chandy⁴, Philip Joseph³

Affiliations

¹ Division of Critical Care, CMC Hospital, Vellore, Tamil Nadu, India.
² Intensive Care Unit, Department of Anaesthesiology, University of Portharcourt, Porthar Court, Nigeria.
³ Department of Hepatobiliary Surgery, CMC Hospital, Vellore, Tamil Nadu, India.
⁴ Department of Anaesthesia, CMC Hospital, Vellore, Tamil Nadu, India.

Abstract

Background and aims: Whipple procedure is associated with perhaps the most perioperative morbidity and mortality amongst surgical procedures. Current data regarding their ICU profile and outcomes are lacking. Thus, in the present study, we aimed to determine perioperative factors affecting patient-centred outcomes following the Whipple procedure.

Methods: In a cohort of patients undergoing pylorus-sparing pancreaticoduodenectomies, we strove to determine perioperative variables that may impact outcomes. Unfavourable outcomes (composite of mortality, prolonged ICU stay of more than 14 days or ICU readmission) of patients who underwent the procedure were recorded and logistic regressions analysis of significant variables conducted.

Results: Around 68 patients recruited over a 20-month period which included 57 males (83.8%); mean age was 53.4(±11.2) with mean acute physiology and chronic health evaluation (APACHE) II score12.5 (±6.1). Nineteen patients remained intubated at the end of procedures (27.9%). Median ICU stay was 2 days (IQR 2-3). Unfavourable ICU outcomes were 14 in number (20.6%) and 2 (2.9%) hospital deaths occurred. Pulmonary complications occurred in 12 patients (17.7%) and non-pulmonary complications occurred in 41 patients (60.3%). In a multiple logistic regression analysis, the APACHE score 1.34 (1.09-1.64) and pulmonary complications 17.3 (2.1-145) were variables that were identified as predictors of unfavourable outcomes.

Conclusion: The APACHE II score may reliably predict adverse outcomes following Whipple procedure. Although non-pulmonary complications are common, pulmonary complications in these patients adversely impact patient outcomes.

Keywords: Intensive care; Whipple procedure; perioperative complications.