I. L. Leeds1, D. R. Hobson1, J. E. Efron1, E. C. Wick2, F. M. Johnston1 1Johns Hopkins University School Of Medicine,Department Of Surgery,Baltimore, MD, USA 2University Of California – San Francisco,Department Of Surgery,San Francisco, CA, USA
Introduction:
Short-term surgical outcomes at high-quality centers are not affected by race, but racial groups have been found to have differences in care processes. Enhanced Recovery After Surgery (ERAS) pathways have been proposed as one means of standardizing care to eliminate process disparities. The purpose of this study was to demonstrate the relationship between process measures for ERAS pathways and postoperative outcomes.
Methods:
National Surgical Quality Improvement Program (NSQIP) data for a single academic medical center’s colorectal surgery practice was queried for patients undergoing elective colon and rectal resections prior to (Jan 2013-Dec 2013) and following (Jan 2014-June 2016) implementation of a colorectal ERAS pathway. Outcomes for white and non-white patients were analyzed using Chi-square and Wilcox-Mann-Whitney tests to compare pre- and post-implementation surgical outcomes. Then, a prospective ERAS quality monitoring database with specific ERAS pathway process measures was linked to patients’ NSQIP outcomes. ERAS pathway adherence was then further compared to patients’ surgical outcomes with respect to race using logistic regression.
Results:
A total of 357 colon and rectal resections were identified in the institution’s NSQIP database (84 pre-ERAS era, 273 ERAS era). Prior to ERAS implementation average lengths of stay, complication rate, and total number of complications were not statistically different between white and non-white patients. Following ERAS implementation, lengths of stay improved in both whites (-3.3 days, p<0.001) and non-whites (-2.5 days, p=0.002). Complication rates in both racial groups were no different (p=0.304) and trended down after ERAS implementation (25.0% to 19.8%, p=0.304) as well as the average number of complications per surgery (0.33 to 0.27, p=0.335).
A subset of 259 cases (64%) from the ERAS implementation era were identified with complete process measure information. 32 process measures were individually examined with no statistically significant difference between white and non-white patients. Between racial groups within ERAS patients, there was no significant difference in average lengths of stay, complication rates, or number of complications. Length of stay was unaffected by process measure adherence, but adherence was protective for complications of surgery (OR = 0.89, p=0.001).
Conclusion:
When adherence to ERAS pathway processes are followed, surgical outcomes are similar regardless of race. ERAS processes both maintain outcomes parity between racial groups while further improving overall quality outcomes.