620: Enhanced recovery after surgery for cesarean delivery: Reducing healthcare disparity

Abstract

Enhanced recovery after surgery (ERAS) programs aim to achieve impartial surgical healthcare through the utilization of standardized protocols. Our objective was to compare disparities in hospital length of stay (LOS) by insurance payer status before and after the implementation of an ERAS protocol for cesarean delivery (CD). An ERAS-CD program was implemented at our institution in October 2018. Using a healthcare analytics platform, we compared disparities in LOS after delivery (calculated from time of delivery to discharge) based on insurance payer status before (January-June 2018) and after (January-June 2019) ERAS implementation. Student’s T test and Chi square were used for statistical comparison with p< 0.05 considered statistically significant. Continuous data are expressed as mean +/- standard deviation. 883 patients underwent CD in the pre-ERAS group, 763 (86.4%) of whom had private insurance and 120 (13.6%) of whom had Medicaid. In the post-ERAS group, 892 patients had a CD; 783 (87.8%) were privately insured and 109 (12.2%) had Medicaid. Pre-ERAS, patients with Medicaid had a significantly longer mean LOS after CD than those with private insurance (3.33 +/- 1.15 days vs 3.15 +/- 0.90 days, p=0.05). After ERAS implementation, this disparity was no longer seen (2.87 +/- 1.09 days vs 2.69 +/- 0.87 days, p=0.18). Re-admission rates were similar pre- and post-ERAS; 10.8% vs 9.2%, p=0.69 for patients with Medicaid and 3.0% vs 4.0%, p=0.29 for privately insured patients. After the implementation of an ERAS-CD program, we saw a reduction in healthcare disparity as it relates to hospital LOS among patients with Medicaid vs private insurance. We believe that patient education and multidisciplinary, standardized guidelines contributed to this effect. Although our findings show promise in addressing known healthcare disparities, one must equally practice cultural competency and patient-centered care so as to achieve truly impartial surgical healthcare.