Impact of Enhanced Recovery after Surgery Protocol on Reducing Disparity in Perioperative Outcomes in Low-Income Patients Undergoing Colorectal Surgery

Abstract

INTRODUCTION: Low socioeconomic status has been associated with worse perioperative outcomes. Enhanced recovery after surgery (ERAS) protocols have been shown to improve outcomes by providing standardized initiatives that promote early recovery. We hypothesize that an ERAS program can reduce differences in perioperative outcomes after colorectal surgery based on socioeconomic status. METHODS: All patients who underwent colorectal surgery between March 2020 and February 2022 and enrolled in an ERAS program were identified. Neighborhood household income was determined using the US Census Bureau’s data using patients’ ZIP codes. Patients were divided into low- and high-income groups based on the cohort’s median income. Primary outcomes included complication, 30-day readmission, and length of stay (LOS). Secondary outcomes included diet initiation, pain control (in morphine milligram equivalents [MME]), and removal of urinary catheter. RESULTS: Overall, 55 patients underwent operation with an ERAS protocol (26 low-income, 29 high-income). with a median neighborhood income of $57,132. There was no difference in complication (26.9% vs 31%, 0.775) or readmission (19.2% vs 13.8%, p = 0.721), but patients living in low-income neighborhoods had longer hospital LOS of 7.2 days compared with 4.6 days for high-income patients (p = 0.014). Timing of diet initiation (1.6 vs 2 days, p = 0.367), removal of urinary catheter (1.3 vs 2.3 days, p = 0.064) and MME (152.2 vs 438.8, p = 0.497) were similar in both groups (Table). CONCLUSION: ERAS program can help reduce disparity in outcomes in patients living in low-income neighborhoods, but differences remain in LOS. Continued investigation and strategies are needed to overcome disparity in vulnerable patients.