Published online Sep 24, 2022. doi: 10.5306/wjco.v13.i9.738
Peer-review started: May 18, 2022
First decision: July 14, 2022
Revised: July 22, 2022
Accepted: August 17, 2022
Article in press: August 17, 2022
Published online: September 24, 2022
Processing time: 126 Days and 12.8 Hours
Whipple's operations are high-risk operations that should be done in high-volume centers for optimal outcomes. This is supported by data from several high-volume hospitals.
High-volume centers are usually in developed nations. There are no high-volume centers in the West Indies. In this setting, pancreatic surgeons have to perform Whipple's operations in resource-poor, low-volume settings. This scenario is not ideal, but it is the reality on the ground.
We sought to document the clinical outcomes when Whipple's operations were performed in resource-poor, low-volume centers in the West Indies. If the outcomes are poor, this would be impetus not to perform these operations in this setting or to develop service centralization with high-volume centers.
A retrospective audit of all Whipple's operation performed at a referral center over an eight-year period was performed. Data collected from hospital records included: diagnoses, performance scores, estimated operative blood loss, duration of operation, therapeutic outcomes, post-operative morbidity and mortality. Statistical analyses were performed using SPSS version 16.0.
This facility performed 11.25 Whipples procedures per annum. There were 72 patients in the final study population at a mean age of 60.2 years. Open Whipple’s procedures were performed in 70 patients and laparoscopic assisted procedures in 2. Portal vein resection/reconstruction was performed in 19 (26.4%) patients. In patients undergoing open procedures there was 367 ± 54.1 min mean operating time, 1394 ± 656.8 mL mean blood loss, 5.24 ± 7.22 d mean intensive care unit stay and 15.1 ± 9.53 d hospitalization. Six (8.3%) patients experienced minor morbidity, 10 (14%) major morbidity and there were 4 (5.5%) deaths.
Low volume centers in resource poor nations can achieve good short-term outcomes once they pay attention to continuous, adaptive learning. Volume alone should not be used as a marker of quality for patients requiring Whipple’s procedures.
The direction of future research is to identify specific hospital-based pathways and/or team-focused processes that improve clinical outcomes in low-volume facilities.