eP145 - Perioperative Process Metrics and Early Outcomes for Elective ERAS Colorectal Surgery Patients by Race and Socioeconomic Status

Purpose/Background: Clinical pathways standardize care for surgical patients in the pre-, intra-, and post-operative settings and have been shown to mitigate disparities in care. Enhanced recovery after surgery (ERAS) pathways have improved outcomes, including length of stay and complications, in colorectal surgery patients. Meanwhile, Black race and low socioeconomic status (SES) have been associated with worse outcomes in surgical patients. We examined the association between race/ethnicity and SES with process metrics and outcomes in elective ERAS colorectal surgical patients.Methods/Interventions: We performed a retrospective cohort study using a prospectively collected institutional database from 2/2018-2/2021. We included patients undergoing elective colorectal surgery on the ERAS pathway at our academic medical center in Boston. Self-reported race/ethnicity was categorized as non-Hispanic White, non-Hispanic Black, Hispanic/Latino and other. The area deprivation index (ADI) was calculated for each patient using the University of Wisconsin Neighborhood Atlas and used as a proxy measure for SES, which was categorized as low for ADI >50 and/or Medicaid insurance coverage or high for ADI Results/Outcomes: Of 1,519 patients identified, 1,332 (88%) were non-Hispanic White, 77 (5.1%) non-Hispanic Black, and 63 (4.2%) Hispanic/Latino. Our cohort included 1,339 (88%) high SES patients and 180 (12%) low SES patients. Descriptive analyses revealed that non-Hispanic Whites were less likely to be insured by Medicaid than other patients (3.9% vs 23.4% non-Hispanic Black vs 25.4% Hispanic/Latino, p < 0.01). Non-Hispanic Black and Hispanic/Latino patients were more likely to have low SES yet there was no significant difference in ADI by race. In bivariate analysis, non-Hispanic Blacks were less likely to receive preoperative patient education (71.4% vs 85.7% non-Hispanic White, p < 0.01), yet this association was not seen in multivariable regression where no significant associations were noted between race/ethnicity or SES and perioperative process metric rates. Low SES patients were more likely to have longer length of stay compared to high SES patients (4 vs 3 days, p < 0.01). In multivariable analysis, non-Hispanic Black patients had more respiratory complications than non-Hispanic Whites (OR 4.0, p=0.02). There were no significant differences in other postoperative complications or early outcomes by race or SES.Conclusion/

Discussion: In our cohort of elective ERAS colorectal surgery patients, we found no significant associations between race/ethnicity or SES and perioperative process metrics. While non-Hispanic Blacks were found to have increased respiratory complications, no other significant associations were noted between race/ethnicity and early outcomes. Low SES patients had longer lengths of stay. Further study is warranted to investigate how we can improve on the differences in outcomes by race or SES that persist even without differences in our current process measures.