Enhanced Recovery Pathway Improves Colorectal Surgery Outcomes in Private and Safety-Net Settings

Taylor J. Roberts, Joselin L. Matthews, Patty K. Brown, Jerzy R. Lysikowski, Jennifer R. Rabaglia

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)354-359
Number of pages6
JournalJournal of Surgical Research
Volume245
DOIs
StatePublished - Jan 2020
Externally publishedYes

Keywords

  • Clinical pathway
  • Colorectal surgery
  • Enhanced recovery
  • Length of stay
  • Safety net

ASJC Scopus subject areas

  • Surgery

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