Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA.
Penn Medicine Center for Health Equity Advancement, Office of Chief Medical Officer, University of Pennsylvania Health System and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Clin Neurol Neurosurg. 2023 Jan;224:107561. doi: 10.1016/j.clineuro.2022.107561. Epub 2022 Dec 13.
Prior work reveals that Enhanced Recovery After Surgery (ERAS) programs decrease opioid use, improve mobilization, and shorten length of stay (LOS) among patients undergoing spine surgery. The impact of ERAS on outcomes by race/ethnicity is unknown. This study examined outcomes by race/ethnicity among neurosurgical patients enrolled in an ERAS program.
Patients undergoing elective spine or peripheral nerve surgeries at a multi-hospital university health system from April 2017 to November 2020 were enrolled in an ERAS program that involves preoperative, perioperative, and postoperative phases focused on improving outcomes through measures such as specialty consultations for co-morbidities, multimodal analgesia, early mobilization, and wound care education. The following outcomes for ERAS patients were compared by race/ethnicity: length of stay, discharge disposition, complications, readmission, pain level at discharge, and post-operative health rating. We estimated the association between race/ethnicity and the outcomes using linear and logistic regression models adjusting for age, sex, insurance, BMI, comorbid conditions, and surgery type.
Among participants (n = 3449), 2874 (83.3%) were White and 575 (16.7%) were Black, Indigenous, and people of color (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 as compared to White ERAS participants in ERAS undergoing neurosurgical procedures had significantly longer hospital stays and were significantly less likely to be discharged home. ERAS protocols present an opportunity to provide consistent high quality post-operative care, however while there is evidence that it improves care in aggregate, our results suggest significant disparities in outcomes by patient race/ethnicity despite enrollment in ERAS. Future inquiry must identify contributors to these disparities in the recovery pathway.
先前的研究表明，加速康复外科（ERAS）方案可减少接受脊柱手术患者的阿片类药物使用量、提高活动能力并缩短住院时间（ LOS ）。但 ERAS 方案对不同种族/族裔患者的影响尚不清楚。本研究旨在探讨接受 ERAS 方案治疗的神经外科患者的种族/族裔差异。
本研究纳入了 2017 年 4 月至 2020 年 11 月在一所多医院大学健康系统接受择期脊柱或周围神经手术的患者，这些患者均参与了 ERAS 方案，该方案包括术前、围术期和术后阶段，通过针对合并症的专科会诊、多模式镇痛、早期活动和伤口护理教育等措施来改善结局。比较了接受 ERAS 方案的患者的以下结局：住院时间、出院去向、并发症、再入院、出院时疼痛水平和术后健康评分。我们使用线性和逻辑回归模型，通过调整年龄、性别、保险、BMI、合并症和手术类型等因素，估计了种族/族裔与结局之间的关联。
在参与者（n=3449）中，2874 名（83.3%）为白人，575 名（16.7%）为黑人、原住民和有色人种（BIPOC）。与白人患者相比，BIPOC 患者的平均住院时间明显更长（3.8 天 vs. 3.4 天，p=0.005），且更有可能被送往康复或亚急性护理机构（调整后的优势比（95%可信区间）：3.01（2.26-4.01），p<0.001）。BIPOC 患者的并发症发生率与白人患者无显著差异（13.7% vs. 15.5%，p=0.29）。在调整后的模型中，BIPOC 患者 30 天内再入院的可能性与白人患者相比无显著差异（调整后的优势比（95%可信区间）：1.30（0.91-1.86），p=0.15）。
与接受 ERAS 方案的白人神经外科患者相比，BIPOC 患者的住院时间明显更长，出院回家的可能性明显更低。ERAS 方案提供了提供一致的高质量术后护理的机会，然而，尽管证据表明它总体上改善了护理效果，但我们的研究结果表明，尽管患者参与了 ERAS 方案，但在结局方面仍存在显著的种族/族裔差异。未来的研究必须确定恢复途径中这些差异的促成因素。
