TY - JOUR
T1 - Enhanced Recovery Pathway Improves Colorectal Surgery Outcomes in Private and Safety-Net Settings
AU - Roberts, Taylor J.
AU - Matthews, Joselin L.
AU - Brown, Patty K.
AU - Lysikowski, Jerzy R.
AU - Rabaglia, Jennifer R.
N1 - Funding Information:
Funding for this study was provided by the University of Texas Southwestern Medical Center Office of Quality Improvement. Authors' contributions: T.J.R. participated in data collection and drafted the manuscript. J.L.M. and J.R.R. designed the study and edited the manuscript. P.K.B. participated in data collection, data analysis, and manuscript editing. J.R.L. led data analysis and created graphics.
Publisher Copyright:
© 2019
PY - 2020/1
Y1 - 2020/1
N2 - Background: Enhanced recovery pathways (ERPs) can decrease length of stay (LOS) and improve colorectal surgery outcomes in private health care; however, their efficacy in the public realm, comprised largely of underserved and uninsured patients, remains uncertain. Materials and methods: An ERP without social interventions was implemented at a private hospital (PH) and a safety-net hospital (SNH) within a large academic medical center in 2014. Process and outcome metrics from 100 patients in the 18 mo before ERP implementation at each institution were retrospectively compared with a similar group after ERP implementation. Primary outcomes were LOS, 30-d readmission, and reoperation. Results: Post-ERP groups were older than pre-ERP (P = 0.047, 0.034), with no difference in sex or body mass index. Rate of open versus minimally invasive was similar at the SNH (P = 0.067), whereas more post-ERP patients at PH underwent open surgery (P = 0.002). Ninety six percentage of PH patients were funded through private insurance or Medicare, verses 6% at the SNH. LOS at PH decreased from 8.1 to 5.9 d (P = 0.028) and at SNH from 7.0 to 5.1 d (P = 0.004). There was no change in 30-d all-cause readmission (PH P = 0.634; SNH P = 1) or reoperation (PH P = 0.610; SNH P = 0.066). Conclusions: ERP reduced LOS in both private and safety-net settings without addressing social determinants of health. Readmission and reoperation rates were unchanged. As health care moves toward a bundled payment model, ERP can help optimize outcomes and control costs in the public arena.
AB - Background: Enhanced recovery pathways (ERPs) can decrease length of stay (LOS) and improve colorectal surgery outcomes in private health care; however, their efficacy in the public realm, comprised largely of underserved and uninsured patients, remains uncertain. Materials and methods: An ERP without social interventions was implemented at a private hospital (PH) and a safety-net hospital (SNH) within a large academic medical center in 2014. Process and outcome metrics from 100 patients in the 18 mo before ERP implementation at each institution were retrospectively compared with a similar group after ERP implementation. Primary outcomes were LOS, 30-d readmission, and reoperation. Results: Post-ERP groups were older than pre-ERP (P = 0.047, 0.034), with no difference in sex or body mass index. Rate of open versus minimally invasive was similar at the SNH (P = 0.067), whereas more post-ERP patients at PH underwent open surgery (P = 0.002). Ninety six percentage of PH patients were funded through private insurance or Medicare, verses 6% at the SNH. LOS at PH decreased from 8.1 to 5.9 d (P = 0.028) and at SNH from 7.0 to 5.1 d (P = 0.004). There was no change in 30-d all-cause readmission (PH P = 0.634; SNH P = 1) or reoperation (PH P = 0.610; SNH P = 0.066). Conclusions: ERP reduced LOS in both private and safety-net settings without addressing social determinants of health. Readmission and reoperation rates were unchanged. As health care moves toward a bundled payment model, ERP can help optimize outcomes and control costs in the public arena.
KW - Clinical pathway
KW - Colorectal surgery
KW - Enhanced recovery
KW - Length of stay
KW - Safety net
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U2 - 10.1016/j.jss.2019.07.067
DO - 10.1016/j.jss.2019.07.067
M3 - Article
C2 - 31425875
AN - SCOPUS:85070615280
SN - 0022-4804
VL - 245
SP - 354
EP - 359
JO - Journal of Surgical Research
JF - Journal of Surgical Research
ER -