840 Reducing healthcare disparities using enhanced recovery after surgery for cesarean delivery

Abstract

Enhanced recovery after surgery 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 race-ethnicity before and after the implementation of an enhanced recovery after surgery for cesarean delivery (ERAS-CD) program. 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) and 30-day readmission rates (defined as any inpatient hospitalization within 30 days of delivery) based on race-ethnicity before (October 2017 – September 2018) and after (November 2018 – October 2019) ERAS-CD implementation. We excluded any outliers, defined as a LOS >25 days using the Academic Medical Center model, and any patients without reported race-ethnicity. Student’s T test and Chi square were used for comparison with p<0.05 considered statistically significant. Continuous data are expressed as mean +/- standard deviation. After applying exclusion criteria, 1520 patients underwent cesarean delivery in the pre-ERAS-CD group and 1522 in the post-ERAS-CD group. Before ERAS-CD implementation, Asian, Black, Hispanic and patients of other race-ethnicity all had a significantly longer mean LOS after cesarean delivery as compared to White patients. After ERAS-CD implementation, this disparity was no longer seen (Table 1). 30-day readmission rates were similar pre- and post-ERAS-CD in patients of all race-ethnicities. After the implementation of an ERAS-CD program, we saw a reduction in healthcare disparity as it relates to hospital LOS, without an increase in readmission rates. We believe that consistent 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 to achieve truly impartial surgical healthcare.