S. L. Rakestraw1, A. Lucy1, L. Wood2, D. Chu2, J. Grams2, R. Stahl2, M. N. Mustian2 1University Of Alabama at Birmingham, Surgery, Birmingham, Alabama, USA 2University Of Alabama at Birmingham, Gastrointestinal Surgery, Birmingham, Alabama, USA
Introduction:
Enhanced Recovery Programs (ERPs) have been implemented across various surgical subspecialties and have been shown to improve postoperative outcomes such as decreased length-of-stay (LOS). Previous studies have also demonstrated that ERPs are associated with diminishing racial disparities through standardization of care. Therefore, following bariatric surgery ERP implementation at a single institution, this study sought to evaluate the relationship between ERP and LOS and to assess whether there was any impact on perioperative racial disparities.
Methods: A retrospective cohort study was performed using data from a single institution, where bariatric ERP was implemented in January 2020. Inclusion criteria consisted of all patients undergoing minimally invasive sleeve gastrectomy or roux-en-y gastric bypass from January 2017- May 2022. The cohort was then stratified by era, comparing the patients pre (2017-2019) and post-ERP (2020-2022) implementation. Multivariable logistic regression was used to assess estimated LOS by era and race (Black and White). Categorical data was compared using chi-square tests and continuous data was compared using Kruskal-Wallis rank sum tests.
Results: The retrospective cohort consisted of 707 patients, including 366 pre-ERP and 404 post-ERP. Pre and post-ERP cohorts were similar in age (median 44.3 years vs. 43.9 years, p=0.81), race (53.0% Black vs. 55.9% Black, p=0.73), and pre-operative BMI (median 48.3 vs. 49.1, p=0.14). Procedures (73.8% vs. 72.5% sleeve gastrectomies, p=.7) and procedure length (median 109.5 vs. 106 minutes, p=0.16) were similar in both eras. Following ERP implementation, the overall median LOS following bariatric surgery decreased from 2 days to 1 day (p<0.001). Average estimated LOS for Black and White patients decreased by 0.5 and 0.48 days respectively. However, overall estimated LOS remained greater for Black patients compared with their White counterparts (Table 1). Other patient factors associated with increased LOS were the requirement of postoperative transfusions, anastomotic leaks, history of foregut surgery, and anticoagulation.
Conclusion: Implementation of a bariatric ERP was associated with decreased LOS for both Black and White patients. However, Black patients did have slightly longer LOS than White patients in both the pre- and post-ERP eras. More work remains to be done in order to assess the underlying causes leading to racial disparities in LOS in order to further mitigate these differences.
