Medical Student Perelman School of Medicine at the University of Pennsylvania Philadelphia, Pennsylvania, United States
Disclosure(s):
Canada T. Montgomery, BS: No financial relationships to disclose
Introduction: Enhanced Recovery After Surgery (ERAS) programs have been shown to decrease opioid use, improve mobilization, and shorten length of stay (LOS) among patients undergoing spine surgery. However, the impact of ERAS on outcomes by race/ethnicity is less well known. We examined outcomes by race/ethnicity among neurosurgical patients enrolled in a single institution ERAS program.
Methods: Adult patients undergoing elective spine or peripheral nerve surgeries were enrolled in ERAS between April 2017 and November 2020. We compared our two patient populations, BIPOC (Black, Indigenous, and people of color) versus non-Hispanic Whites, using descriptive analyses. We estimated the association between race/ethnicity and ERAS patient outcome metrics, using linear and logistic regression models adjusted for age, sex, insurance, BMI, comorbid conditions, and surgery type.
Results: Among participants (n = 3449), 2874 (83.3%) were White and 575 (16.7%) were BIPOC. BIPOC patients had significantly longer mean length of stay compared to White patients (3.8 vs. 3.4 days, p = 0.005) and were significantly more likely to be discharged to a rehab or subacute nursing facility compared to White patients (adjusted odds ratio (95% CI): 3.01 (2.26-4.01), p < 0.001). The complication rate did not significantly differ between BIPOC and White patients (13.7% vs. 15.5%, p = 0.29). BIPOC patients were not significantly more likely to be readmitted within 30 days compared to White patients in the adjusted model (adjusted odds ratio (95% CI): 1.30 (0.91-1.86), p = 0.15).
Conclusion : BIPOC compared to non-Hispanic White ERAS patients undergoing neurosurgical procedures had significantly longer hospital stays, lower one-month overall health rating, and were less likely to be discharged home, even after model adjustment. Our results suggest significant disparities in outcomes by patient race/ethnicity exist. Future inquiry must identify contributors to these disparities to ensure ERAS is implemented equitably and to achieve consistent high-quality post-operative care.
