Comparison of Enhanced Recovery After Surgery (ERAS) metrics by race among gynecologic oncology patients: Ensuring equitable outcomes (006)

Abstract

Objectives: Race and ethnicity data are not routinely reported in the auditing of Enhanced recovery after surgery (ERAS) pathways. Given known racial disparities in outcomes among gynecologic oncology patients, the purpose of this study was to compare differences in ERAS metrics by race. Methods: A cohort study was performed among gynecologic oncology patients enrolled in an ERAS pathway at one academic institution from March 2017 to July 2021. Demographic factors and compliance with preoperative, intraoperative, and postoperative ERAS metrics were compared by race using t-test and Chi-square analyses. Postoperative complications, 30-day survival, reoperations, intensive care unit (ICU) transfers, and re-admission within 30 days were also compared by race using Chi-square and multivariate logistic regressions (adjusted for age, body mass index, and diagnosis). Results: Of 1015 patients identified (83.9% White, 16.1% non-White), 94.2% underwent laparotomy. Non-White women were younger (54.3 years ± 13.5 vs 60.8 years ± 13.3, p<0.001) and less likely to speak English (76.1% vs 97.1%, p<0.001). Fewer non-White women had ovarian cancer than White women (45.4% vs 58.6%, p<0.002). Fewer non-White women received preadmission ERAS education (71.2% vs 79.8%, p=0.014) and fewer received oral bowel preparation (33.1% vs 47.1%) compared to White women. However, there were no differences in rates of preoperative nutritional assessment, carbohydrate loading, antibiotic prophylaxis prior to incision, or thrombosis prophylaxis by race. Intraoperative and postoperative metrics did not differ by race, including surgical approach, blood loss, length of incision, core body temperature, intravenous crystalloid and blood products given, length of operation, length of stay, resection site drainage, use of a nasogastric tube, and mobilization on the day of surgery. A higher percentage of non-White patients experienced complications during their primary stay than White patients (34.4% vs 26.5%, p=0.041, see Table 1). When analyzed by complication type, non-White women had more anesthesia complications (5.5% vs 1.8%, p=0.004), hypotension (5.5% vs 1.2%, p<0.001), and surgical complications (11.7% vs 7.0%, p=0.044) compared to White women. However, no differences were noted in complications after the primary stay, 30-day survival, reoperation, ICU transfer, or readmission. On multivariate logistic regression, non-White women were more likely to experience complications during the primary stay (OR: 1.8, 95% CI: 1.2-2.6, p=0.007) after adjusting for confounders. Objectives: Race and ethnicity data are not routinely reported in the auditing of Enhanced recovery after surgery (ERAS) pathways. Given known racial disparities in outcomes among gynecologic oncology patients, the purpose of this study was to compare differences in ERAS metrics by race. Methods: A cohort study was performed among gynecologic oncology patients enrolled in an ERAS pathway at one academic institution from March 2017 to July 2021. Demographic factors and compliance with preoperative, intraoperative, and postoperative ERAS metrics were compared by race using t-test and Chi-square analyses. Postoperative complications, 30-day survival, reoperations, intensive care unit (ICU) transfers, and re-admission within 30 days were also compared by race using Chi-square and multivariate logistic regressions (adjusted for age, body mass index, and diagnosis). Results: Of 1015 patients identified (83.9% White, 16.1% non-White), 94.2% underwent laparotomy. Non-White women were younger (54.3 years ± 13.5 vs 60.8 years ± 13.3, p<0.001) and less likely to speak English (76.1% vs 97.1%, p<0.001). Fewer non-White women had ovarian cancer than White women (45.4% vs 58.6%, p<0.002). Fewer non-White women received preadmission ERAS education (71.2% vs 79.8%, p=0.014) and fewer received oral bowel preparation (33.1% vs 47.1%) compared to White women. However, there were no differences in rates of preoperative nutritional assessment, carbohydrate loading, antibiotic prophylaxis prior to incision, or thrombosis prophylaxis by race. Intraoperative and postoperative metrics did not differ by race, including surgical approach, blood loss, length of incision, core body temperature, intravenous crystalloid and blood products given, length of operation, length of stay, resection site drainage, use of a nasogastric tube, and mobilization on the day of surgery. A higher percentage of non-White patients experienced complications during their primary stay than White patients (34.4% vs 26.5%, p=0.041, see Table 1). When analyzed by complication type, non-White women had more anesthesia complications (5.5% vs 1.8%, p=0.004), hypotension (5.5% vs 1.2%, p<0.001), and surgical complications (11.7% vs 7.0%, p=0.044) compared to White women. However, no differences were noted in complications after the primary stay, 30-day survival, reoperation, ICU transfer, or readmission. On multivariate logistic regression, non-White women were more likely to experience complications during the primary stay (OR: 1.8, 95% CI: 1.2-2.6, p=0.007) after adjusting for confounders.