Patients undergoing colorectal surgery at a Veterans Affairs Hospital do not experience racial disparity in length of stay either before or after implementing an enhanced recovery pathway

C Rentas; S Baker; L Goss; J Richman; S J Knight; C Key; M Morris

doi:10.1186/s12893-022-01647-3

Patients undergoing colorectal surgery at a Veterans Affairs Hospital do not experience racial disparity in length of stay either before or after implementing an enhanced recovery pathway

BMC Surg. 2022 May 21;22(1):201. doi: 10.1186/s12893-022-01647-3.

Authors

C Rentas¹, S Baker^{2

3}, L Goss³, J Richman^{2

3}, S J Knight⁴, C Key^{2

3}, M Morris^{2

3}

Affiliations

¹ Department of Surgery, University of Alabama at Birmingham School of Medicine, 1808 7th Avenue South #503, Birmingham, AL, 35233, USA. cmrentas@uab.edu.
² Department of Surgery, University of Alabama at Birmingham School of Medicine, 1808 7th Avenue South #503, Birmingham, AL, 35233, USA.
³ Birmingham VA Medical Center, 700 19th Street South, Birmingham, AL, 35233, USA.
⁴ VA Salt Lake City Health Care System, University of Utah, 500 Foothill Dr, Salt Lake City, UT, 84148, USA.

Abstract

Background: Enhanced Recovery Pathways (ERP) have been shown to reduce racial disparities following surgery. The objective of this study is to determine whether ERP implementation mitigates racial disparities at a Veterans Affairs Hospital.

Methods: A retrospective cohort study was conducted using data obtained from the Veterans Affairs Surgical Quality Improvement Program. All patients undergoing elective colorectal surgery following ERP implementation were included. Current procedural terminology (CPT) codes were used to identify patients who underwent similar procedures prior to ERP implementation.

Results: Our study included 417 patients (314 pre-ERP vs. 103 ERP), 97.1% of which were male, with an average age of 62.32 (interquartile range (IQR): 25-90). ERP patients overall had a significantly shorter post-operative length of stay (pLOS) vs. pre-ERP patients (median 4 days (IQR: 3-6.5) vs. 6 days (IQR: 4-9) days (p < 0.001)). Within the pre-ERP group, median pLOS for both races was 6 days (IQR: 4-6; p < 0.976) and both groups experienced a decrease in median pLOS (4 vs. 6 days; p < 0.009 and p < 0.001) following ERP implementation.

Conclusions: Racial disparities did not exist in patients undergoing elective surgery at a single VA Medical Center. Implementation of an ERP significantly reduced pLOS for black and white patients.

Keywords: Disparities; Enhanced Recovery Pathways; Race; Veterans Affairs.

MeSH terms

Colorectal Surgery*
Female
Hospitals
Humans
Length of Stay
Male
Middle Aged
Retrospective Studies
Veterans*