Quality surgery for gastrointestinal cancers in the Deep South: Disparities in elements of the Enhanced Recovery Program.

Abstract

183 Background: Disparities in surgical outcomes exist for Black gastrointestinal cancer patients and may be due to the lower likelihood of undergoing quality surgery that minimizes adverse surgical outcomes. The Enhanced Recovery Program (ERP) has shown to improve perioperative outcomes through standardization of care and to reduce disparities in surgical outcomes in certain settings. The extent to which ERP is applied across patient groups is currently unclear, especially for patients in high poverty states of the Deep South. Methods: The ASCENDS study conducted a survey of colorectal, pancreatic, and esophageal cancer patients (stage 1-3, diagnosed within 5 years, had surgery) in Alabama and Mississippi. Survivors were recruited through the Alabama Statewide Cancer Registry and select hospitals in these states. Survey questions asked about selected ERP components including: 1) education and counseling about surgery, i.e., i) surgeon/other health care provider in surgery clinic gave instructions about getting ready for surgery, ii) instructions were definitely easy to understand; 2) carbohydrate drink before surgery (e.g., Sprite); 3) pain medication; 4) anti-thrombotic and antibiotic prophylaxis; 5) bladder catheter (removed day after surgery); 6) early mobilization (walking) and nutrition on day of surgery, and mobilization the day after surgery. Fisher Exact or Chi Square tests were performed to examine significant differences across White (W) and Black, Indigenous, or persons of color (BIPOC) respondents. Results: Of 272 survey respondents (mean age 63.17±11.57, range 23-92), 71.3% were W, 28.3% BIPOC, 55.5% women, 76.8% had colorectal,16.2% pancreatic, and 7% esophageal cancer, 58.8% were from rural areas, 33.8% had low health literacy, 46.7% had private insurance, 32.3% Medicaid or Medicare/Medicaid, and 21.7% Medicare. See Table 1. Conclusions: Overall, there were no disparities in ERP components as recalled by survey respondents. Low uptake of some of the ERP components is worrisome, although data from medical records is needed to confirm findings. Improvements may be needed to improve surgery outcomes for alI GI cancer patients in the Deep South.[Table: see text]