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Enhanced Recovery After Surgery (ERAS) Eliminates Racial Disparities in Postoperative Length of Stay After Colorectal Surgery
- Source :
- Ann Surg
- Publication Year :
- 2018
-
Abstract
- 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.
- Subjects :
- Adult
Male
medicine.medical_specialty
Quality management
education
Treatment outcome
MEDLINE
Patient Readmission
Article
White People
03 medical and health sciences
fluids and secretions
0302 clinical medicine
Postoperative Complications
Quality of life
parasitic diseases
medicine
Humans
Enhanced recovery after surgery
Aged
Critical pathways
business.industry
General surgery
Recovery of Function
Length of Stay
Middle Aged
Quality Improvement
Colorectal surgery
body regions
Black or African American
Treatment Outcome
030220 oncology & carcinogenesis
Alabama
Critical Pathways
Quality of Life
030211 gastroenterology & hepatology
Surgery
Female
business
Colorectal Surgery
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- Ann Surg
- Accession number :
- edsair.doi.dedup.....5f1ccc94fa441e3ce67259b211b4a7bf