Department of Surgery, University of Alabama at Birmingham, Birmingham, AL.
Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL.
Ann Surg. 2018 Dec;268(6):1026-1035. doi: 10.1097/SLA.0000000000002307.
To investigate the effects of enhanced recovery after surgery (ERAS) on racial disparities in postoperative length of stay (pLOS) after colorectal surgery.
Racial disparities in surgical outcomes exist. We hypothesized that ERAS would reduce disparities in pLOS between black and white patients.
Patients undergoing ERAS in 2015 were 1:1 matched by race/ethnicity, age, sex, and procedure to a pre-ERAS group from 2010 to 2014. After stratification by race/ethnicity, expected pLOS was calculated using the American College of Surgeons National Surgical Quality Improvement Project Risk Calculator. Primary outcome was the observed pLOS and observed-to-expected difference in pLOS. Secondary outcomes were National Surgical Quality Improvement Project postoperative complications including 30-day readmissions and mortality. Adjusted sensitivity analyses on pLOS were also performed.
Of 420 patients (210 ERAS and 210 pre-ERAS) examined, 28.3% were black. Black and white patients were similar in age, body mass index, sex, American Anesthesia Association class, and minimally invasive approaches. Within the pre-ERAS group, black patients stayed a mean of 2.7 days longer than expected compared with white patients (P < 0.05). Overall, ERAS patients had a significantly shorter pLOS (5.7 vs 8 days) and observed-to-expected difference (-0.7 vs 1.4 days) compared with pre-ERAS patients (P < 0.01). In the ERAS group, disparities in pLOS were reduced with no differences in readmissions or mortality between black and white patients. On sensitivity analyses, race/ethnicity remained a significant predictor of pLOS among pre-ERAS patients, but not for ERAS patients.
ERAS eliminated racial differences in pLOS between black and white patients undergoing colorectal surgery. Reduced pLOS occurred without increases in mortality, readmissions, and most postoperative complications. ERAS may provide a practical approach to reducing disparities in surgical outcomes.
研究术后恢复加速（ERAS）对结直肠手术后住院时间（pLOS）种族差异的影响。
手术结果存在种族差异。我们假设 ERAS 将减少黑人和白人患者之间 pLOS 的差异。
2015 年接受 ERAS 的患者按种族/民族、年龄、性别和手术方式 1:1 与 2010 年至 2014 年的 ERAS 前组相匹配。按种族/民族分层后，使用美国外科医师学会国家手术质量改进计划风险计算器计算预期的 pLOS。主要结果是观察到的 pLOS 和 pLOS 的观察到的预期差异。次要结果包括国家手术质量改进计划术后并发症，包括 30 天再入院和死亡率。还对 pLOS 进行了调整后的敏感性分析。
在 420 名患者（210 名 ERAS 和 210 名 ERAS 前）中，28.3%为黑人。黑人患者和白人患者在年龄、体重指数、性别、美国麻醉医师协会分级和微创手术方法方面相似。在 ERAS 前组中，黑人患者的住院时间比白人患者平均长 2.7 天（P < 0.05）。总体而言，ERAS 患者的 pLOS 明显更短（5.7 天比 8 天），观察到的与预期的差异更小（-0.7 天比 1.4 天）与 ERAS 前组患者相比（P < 0.01）。在 ERAS 组中，pLOS 的差异缩小，黑人患者和白人患者的再入院率或死亡率无差异。在敏感性分析中，种族/民族仍然是 ERAS 前患者 pLOS 的一个显著预测因素，但不是 ERAS 患者。
ERAS 消除了黑人和白人结直肠手术患者 pLOS 之间的种族差异。pLOS 的减少没有导致死亡率、再入院率和大多数术后并发症的增加。ERAS 可能是减少手术结果差异的一种实用方法。
