OBJECTIVE: To investigate the effects of enhanced recovery after surgery (ERAS) on racial disparities in postoperative length of stay (pLOS) after colorectal surgery. BACKGROUND: Racial disparities in surgical outcomes exist. We hypothesized that ERAS would reduce disparities in pLOS between black and white patients. METHODS: Patients undergoing ERAS in 2015 were 1:1 matched by race/ethnicity, age, sex, and procedure to a pre-ERAS group from 2010 to 2014. After stratification by race/ethnicity, expected pLOS was calculated using the American College of Surgeons National Surgical Quality Improvement Project Risk Calculator. Primary outcome was the observed pLOS and observed-to-expected difference in pLOS. Secondary outcomes were National Surgical Quality Improvement Project postoperative complications including 30-day readmissions and mortality. Adjusted sensitivity analyses on pLOS were also performed. RESULTS: Of 420 patients (210 ERAS and 210 pre-ERAS) examined, 28.3% were black. Black and white patients were similar in age, body mass index, sex, American Anesthesia Association class, and minimally invasive approaches. Within the pre-ERAS group, black patients stayed a mean of 2.7 days longer than expected compared with white patients (P < 0.05). Overall, ERAS patients had a significantly shorter pLOS (5.7 vs 8 days) and observed-to-expected difference (-0.7 vs 1.4 days) compared with pre-ERAS patients (P < 0.01). In the ERAS group, disparities in pLOS were reduced with no differences in readmissions or mortality between black and white patients. On sensitivity analyses, race/ethnicity remained a significant predictor of pLOS among pre-ERAS patients, but not for ERAS patients. CONCLUSIONS: ERAS eliminated racial differences in pLOS between black and white patients undergoing colorectal surgery. Reduced pLOS occurred without increases in mortality, readmissions, and most postoperative complications. ERAS may provide a practical approach to reducing disparities in surgical outcomes.
OBJECTIVE: To investigate the effects of enhanced recovery after surgery (ERAS) on racial disparities in postoperative length of stay (pLOS) after colorectal surgery. BACKGROUND: Racial disparities in surgical outcomes exist. We hypothesized that ERAS would reduce disparities in pLOS between black and white patients. METHODS:Patients undergoing ERAS in 2015 were 1:1 matched by race/ethnicity, age, sex, and procedure to a pre-ERAS group from 2010 to 2014. After stratification by race/ethnicity, expected pLOS was calculated using the American College of Surgeons National Surgical Quality Improvement Project Risk Calculator. Primary outcome was the observed pLOS and observed-to-expected difference in pLOS. Secondary outcomes were National Surgical Quality Improvement Project postoperative complications including 30-day readmissions and mortality. Adjusted sensitivity analyses on pLOS were also performed. RESULTS: Of 420 patients (210 ERAS and 210 pre-ERAS) examined, 28.3% were black. Black and white patients were similar in age, body mass index, sex, American Anesthesia Association class, and minimally invasive approaches. Within the pre-ERAS group, black patients stayed a mean of 2.7 days longer than expected compared with white patients (P < 0.05). Overall, ERAS patients had a significantly shorter pLOS (5.7 vs 8 days) and observed-to-expected difference (-0.7 vs 1.4 days) compared with pre-ERAS patients (P < 0.01). In the ERAS group, disparities in pLOS were reduced with no differences in readmissions or mortality between black and white patients. On sensitivity analyses, race/ethnicity remained a significant predictor of pLOS among pre-ERAS patients, but not for ERAS patients. CONCLUSIONS: ERAS eliminated racial differences in pLOS between black and white patients undergoing colorectal surgery. Reduced pLOS occurred without increases in mortality, readmissions, and most postoperative complications. ERAS may provide a practical approach to reducing disparities in surgical outcomes.
Authors: Samuel R Montgomery; Paris D Butler; Chris J Wirtalla; Karole T Collier; Rebecca L Hoffman; Cary B Aarons; Scott M Damrauer; Rachel R Kelz Journal: Am J Surg Date: 2018-05-12 Impact factor: 2.565
Authors: Numa P Perez; Maggie L Westfal; Sahael M Stapleton; Fatima Cody Stanford; Cornelia L Griggs; Janey S Pratt; David C Chang; Cassandra M Kelleher Journal: Surg Obes Relat Dis Date: 2019-12-04 Impact factor: 4.734
Authors: Douglas S Swords; Brian K Bednarski; Craig A Messick; Matthew M Tillman; George J Chang; Y Nancy You Journal: Ann Surg Oncol Date: 2021-08-18 Impact factor: 5.344
Authors: Mayou Martin T Tampo; Mark Augustine S Onglao; Marc Paul J Lopez; Marie Dione P Sacdalan; Ma Concepcion L Cruz; Rosielyn T Apellido; Hermogenes J Monroy Iii Journal: Ann Coloproctol Date: 2020-09-18
Authors: Lauren M Theiss; Tara Wood; Marshall C McLeod; Connie Shao; Isabel Dos Santos Marques; Swara Bajpai; Elizabeth Lopez; Anh M Duong; Robert Hollis; Melanie S Morris; Daniel I Chu Journal: Am J Surg Date: 2021-10-16 Impact factor: 3.125
Authors: JoAnne E Natale; Lisa A Asaro; Jill G Joseph; Christine Ulysse; Judith Ascenzi; Cindy Bowens; David Wypij; Martha A Q Curley Journal: Ann Am Thorac Soc Date: 2021-01