C. M. Rentas1, L. Goss1, S. Baker1, J. Richman1, S. Knight1, M. Morris1 1University Of Alabama at Birmingham,Birmingham, Alabama, USA
Introduction: Racial disparities in post-operative length of stay (pLOS) exist. Enhanced Recovery After Surgery (ERAS) has been shown to reduce racial disparities following surgery at large Academic Medical Centers. We hypothesized that racial disparities in pLOS exist among veterans at a Veterans Affairs Hospital and implementation of an ERAS protocol would mitigate these disparities.
Methods: A cohort study was conducted at the Birmingham VA Medical Center between January 2012 and March 2018 for patients undergoing elective general surgery. All patients that underwent an operation using the ERAS protocol between January 2016- March 2018 were identified as ERAS patients. CPT Codes identified pre-ERAS patients that underwent similar operations from January 2012- January 2016. Demographic and procedural information was collected through Veterans Affairs Surgical Quality Improvement Program (VASQIP). Patients undergoing emergent surgery or who had an in-hospital mortality were excluded. The primary outcome assessed was the pLOS between the two racial groups (Black vs. White). Patient demographics, surgery characteristics, and complication rates were compared across groups using student’s t-test. Wilcoxon-ranked test was used to determine median LOS.
Results: Of 584 patients included (445 pre-ERAS vs. 139 ERAS), 36.1% were black. The average age of the cohort was 61.4 (SD 10.4) and 96% were male. Black and white patients were similar in age, body mass index, sex, and American Society of Anesthesiology class. Overall, ERAS patients had a significantly shorter pLOS (4 vs. 6 days) when compared with pre-ERAS patients (p<0.0001). Within the pre-ERAS group, median pLOS for black patients was 7 days and 6 days for white patients (p<0.44). Both groups experienced a decrease in length of stay from ERAS implementation. When compared to the pre-ERAS pathway, patients treated under the ERAS pathway had significantly shorter lengths of stay: black patients median pLOS of 4 days (IQR: 3-13) vs. 7 days, p<0.0237 and white patients median pLOS of 5 days (IQR: 3-7) vs. 6 days, p<0.0001. After implementation of the ERAS pathway, black and white patients had a similar pLOS (4 vs. 5 days, p<0.17).
Conclusion: Contrary to data published in non-VA settings, racial disparities did not exist in patients undergoing colorectal surgery. Implementation of an ERAS pathway significantly reduced pLOS for both black and white patients in the VA hospital system.