M. Waldrop1, L. Wood1, L. M. Theiss1, I. Marques1, K. Hardiman1, D. Gunnells1, J. A. Cannon1, G. Kennedy1, M. S. Morris1, D. I. Chu1 1University Of Alabama at Birmingham,Division Of Gastrointestinal/Department Of Surgery,Birmingham, Alabama, USA
Introduction: Racial disparities in surgical outcomes exist. Enhanced Recovery Protocol (ERP) pathways have been shown to reduce racial disparities in post-operative length-of-stay for colorectal patients, but its effect in the inflammatory bowel disease (IBD) population is unclear.We hypothesized that ERP would reduce racial disparities in surgical outcomes for African-American (AA) patients with IBD.
Methods: Retrospective analysis comparing surgical outcomes in AA and Caucasian-American (CA) patients with IBD before (2006-2014) and after (2015-2019) ERP implementation at a single-institution, tertiary-referral IBD center. Inclusion criteria were surgical patients with an ICD9/ICD-10 diagnosis of Chronic Ulcerative Colitis or Crohn’s Disease. Primary outcomes were 30-day readmission rates and post-operative complications, as defined by the American College of Surgeons National Surgical Quality Improvement Project. Multivariable analyses were used to test the association of race/ethnicity with primary outcomes. All analysis was performed at an alpha level of 0.05.
Results: Of 312 IBD patients evaluated, 16% were AA. Overall mean age was 42 years and 48.7% had Crohn’s disease. Overall 30-day readmission rates and POCs were 16.7% and 35.2%, respectively. Racial disparities existed in the pre-ERP era for readmission rates with 25.8% for AAs compared to 12.7% for CAs (p=0.02). Racial disparities were not observed in POCs. With ERP, readmissions rates for AAs with IBD were reduced from 25.8% pre-ERP to 10% post-ERP (p=0.44). On multivariate analysis, AA race was associated with higher odds of readmission compared to CA patients in the pre-ERP era (OR: 6.94, p=0.04). With ERP, AA race was no longer associated with increased risk of 30-day readmissions.
Conclusion: Racial disparities in readmissions are eliminated for AA patients with IBD under ERP. ERP benefits vulnerable populations and should be standard-of-care.