P. K. Patel1, D. I. Chu1, L. Goss1, J. G. Wiener1, T. S. Wahl1, K. D. Cofer1, J. S. Richman1, M. S. Morris1, J. A. Cannon1, G. D. Kennedy1 1University Of Alabama at Birmingham,Gastrointestinal Surgery,Birmingham, Alabama, USA
Introduction:
Racial disparities have been documented in surgical outcomes. For example, recent studies have shown that black patients have longer length-of-stays (LOS) and higher rates of post-operative complications (POCs) than similar white patients. However, it is unclear if disparities persist between black and white patients who suffer similar inpatient POCs. The primary aim of this study was to assess differences between minority status (white vs. non-white) in the LOS of patients who suffered complications for surgical patients with and without the Enhanced Recovery After Surgery (ERAS) pathway. We hypothesized that minority patients will have longer LOS if they suffer POCs.
Methods:
Using a prospectively maintained database of patients undergoing colorectal surgery before and after the implementation of ERAS at a single institution, we identified patients who suffered a POC using NSQIP variables. The primary outcome was LOS. Bivariate comparisons were made between races and ERAS status using chi square tests, one-way analysis of variances, and the Kruskal-Wallis test.
Results:
Out of a total of 1121 patients, 718 (64%) were pre-ERAS and 403 (36%) underwent ERAS. Of the 718 pre-ERAS patients, 191 (26.6%) were members of a minority group and 527 (73.4%) were white. A total of 201 (28.0%) patients had post-operative complications with rates of 36.1% for minorities and 25.1% for whites (p<0.01). Overall there was a significant difference in LOS between minorities and whites (median 7 days vs. 5 days, p<0.01). Among those without POCs, minorities had a longer LOS (median 6 days vs. 5 days, p=0.01), but there was no difference in LOS for those with a POC (median 8 days vs. 8 days, p=0.95). Of the 403 ERAS patients, 221 (28.9%) were members of minority groups and 543 (71.1%) were white. A total of 106 (26.3%) individuals experienced a POC with rates of 28.6% for minorities and 25.4% for whites (p=0.50). Top complications in ERAS patients were organ space SSI (4.7%), superficial incisional SSI (3.4%), and UTI (2.5%). There was no significant difference in POCs by minority status (p=0.93). LOS did not differ by minority status overall (minority median 3 days vs. 3 days, p=0.50), for patients without complications (3 days vs. 3 days, p=0.58), or for patients with POCs (minority median 6 days vs. 5 days, p=0.26).
Conclusion:
In the pre-ERAS era, racial disparities existed with longer LOS and higher rates of POCs among minority patients. These disparities in LOS, however, appeared to be driven by patients without POCs. Under ERAS, there were no observed racial disparities in LOS, with or without POCs. The effect of ERAS on reducing disparities in LOS may therefore occur through its standardization of recovery pathways for patients without complications.