eP636 - The Impact of Living in an Area of Persistent Poverty on Enhanced Recovery Programs and Colorectal Surgical Outcomes

Purpose/Background: Socioecological determinants of health (SEDOH) have been shown to contribute to surgical disparities, and enhanced recovery programs (ERPs) aim to address these disparities by standardizing perioperative care. Persistent poverty areas (PPAs) have emerged as a way to analyze the intersection of socioeconomic status and geographic access to care to give a more realistic view of how SEDOHs affect surgical outcomes, which is currently unknown. We hypothesized that colorectal surgery patients from PPAs have worse surgical outcomes and that ERPs may mitigate these disparities.Methods/Interventions: We conducted a retrospective cohort study of patients undergoing elective colorectal surgery at a single academic medical center in the Deep South from 2010-2021 where an ERP was implemented in 2015. ACS-NSQIP data was linked to persistent poverty status based on each patient’s census tract. Patients were stratified by PPA status into PPA and non-PPA cohorts. The primary outcomes of interest were hospital length of stay (LOS), complications, and readmission rates. Secondary outcomes of interest were ERP adherence, defined as receiving >70% of ERP components, and implementation of the 10 individual ERP components.Results/Outcomes: The cohort included 1,592 colorectal surgery patients with 374 (23%) living in PPAs. Median age was 59.5 (IQR 47.7-69.4). Overall, patients were more likely to be female (57%), white (67%), and have undergone a laparoscopic procedure (58%). Patients living in PPAs were more likely to be Black (60% vs 21%, p < 0.001), use Medicare (49% vs 39%, p=0.02), smoke (24% vs 14%, p < 0.001), have higher BMIs (median 28.9 vs 27.9, p=0.01), and hypertension (60% vs 49%, p < 0.001). Overall median LOS was 3 days (IQR 1-5) with 37% experiencing complications and 8% being readmitted. Patients from PPAs and non-PPAs had similar lengths of stay, complication rates, and readmission rates in univariate and multivariable models. While receiving care adherent to ERPs was associated with shorter LOS (LR:-1.3, 95%CI:-2.2 to -0.4) and fewer complications (OR: -1.79, 95%CI: -1.1 to -2.8) in univariate models, this was not seen on multivariable models. There were no differences in receiving overall ERP adherent care based on PPA status, but patients from PPAs were less likely to receive preoperative blocks (74% vs 86%, p=0.004). No differences in race, insurance type, BMI, and smoking status were seen when comparing patients before (n=1105) and after (n=487) ERP implementation at our institution.Conclusion/

Discussion: Patients living in PPAs were more likely to be Black, use government insurance, and have higher rates of comorbidities. Patients from PPAs were just as likely to receive ERP adherent care overall but were less likely to receive pain blocks prior to colorectal surgery. Living in PPAs, while not associated with differences in surgical outcomes, may play a role in medical and preoperative disparities, highlighting opportunities to enhance surgical care for patients in PPAs.