Enhanced Recovery After Surgery Protocols May Help Reduce Racial and Socioeconomic Disparities in Cardiac Surgery

Hoyler, Marguerite; White, Robert S.; Tam, Christopher W.

doi:10.1053/j.jvca.2019.07.144

Cited by 14 publications

(6 citation statements)

References 18 publications

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“…Unfortunately, SES disparities are not addressed by standard ERAS protocols and future work will need to focus on different strategies to mitigate their influence. 10 T A B L E 3 Multivariable logistic regression for hospital length of stay performance from 2014 to 2017. 12 Our analysis revealed that Medicaid and self-pay patients were at increased risk of prolonged LOS but not increased odds of mortality.…”

Section: Discussionmentioning

confidence: 99%

“…Literature has suggested that the adoption of enhanced recovery after surgery (ERAS) protocols may have a role in addressing racial disparities through standardization of care and reduction in unintentional treatment heterogeneity. Unfortunately, SES disparities are not addressed by standard ERAS protocols and future work will need to focus on different strategies to mitigate their influence 10 …”

Section: Discussionmentioning

confidence: 99%

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The effect of socioeconomic factors on patient outcomes in cardiac surgery

McLeish

Seadler

Parrado

et al. 2022

Journal of Cardiac Surgery

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Objectives Healthcare delivery is heterogenous; the reasons for this are numerous and complex. Patient‐specific factors including geography, income, insurance status, age, and gender have been shown to bias surgical outcomes. Utilizing a prospectively collected all‐payer database, we aim to evaluate the influence of socioeconomic factors on mortality and length of stay (LOS) after common cardiac surgical procedures. Methods We utilized the National Inpatient Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality for the year 2019. We included patients undergoing coronary artery bypass grafting (CABG), aortic valve replacement (AVR), transcatheter aortic valve replacement (TAVR), and combined AVR/CABG using the 10th revision of the International Classification of Diseases procedure codes. AVR and CABG were combined into a separate cohort as this was felt to represent a different pathology than isolated valvular or coronary arterial disease. Baseline demographics were summarized. Multivariable regression was performed within each procedure group to model the odds of in‐hospital mortality and hospital LOS with age, sex, insurance, zip‐code median household income, and location as predictors. Results Baseline patient characteristics including gender, income, geography, and payer status were similar between CABG, AVR, and AVR/CABG. TAVR patients had a higher proportion of female sex and Medicare as the primary payer, with an overall greater age. Multivariable Cox proportional hazards regression found that higher income was strongly associated with decreased LOS following AVR and CABG, and moderately associated in TAVR and AVR/CABG. Private insurance was associated with a decreased LOS in patients undergoing CABG, AVR, TAVR, and AVR/CABG. Female sex and increased age were associated with increased odds of mortality in TAVR, CABG, and AVR/CABG. Private insurance was associated with a decreased odds of mortality in patients undergoing AVR. Conclusions These findings reveal significant disparities in patient outcomes after routine cardiac operations that are associated with socioeconomic status. Patients who did not have private insurance or had lower incomes were found to be at risk for increased LOS. Women were at a higher risk of mortality for several operations, a finding which has been previously described elsewhere. Private insurance conveyed a decreased odds of mortality in patients undergoing AVR. This data set serves to highlight differences in healthcare outcomes based on a variety of socioeconomic, geographic, and other inherent factors. Additional research is needed to identify the mechanisms behind these disparities with the goal of providing equitable care to all patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The effect of socioeconomic factors on patient outcomes in cardiac surgery

McLeish

Seadler

Parrado

et al. 2022

Journal of Cardiac Surgery

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“…51,52 In other settings, standardizing clinical decisions and postoperative pathways has been shown to reduce racial disparities among surgical patients. 33,53,54,55 Second, the system would not be affected by concern for reported outcome metrics that might otherwise bias surgical judgment. Finally, the system could track not only the patients accepted for surgery but also those declined for surgery, thus providing a mechanism for recognizing biased trends.…”

Section: Patient Selectionmentioning

confidence: 99%

Should We Rely on AI to Help Avoid Bias in Patient Selection for Major Surgery?

2022

AMA Journal of Ethics

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Many regard iatrogenic injuries as consequences of diagnosis or intervention actions. But inaction-not offering indicated major surgerycan also result in iatrogenic injury. This article explores some surgeons' overestimations of operative risk based on patients' race and socioeconomic status as unduly influential in their decisions about whether to perform major cancer or cardiac surgery on some patients with appropriate clinical indications. This article also considers artificial intelligence and machine learning-based clinical decision support systems that might offer more accurate, individualized risk assessment that could make patient selection processes more equitable, thereby mitigating racial and ethnic inequity in cancer and cardiac disease.The American Medical Association designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™ available through the AMA Ed Hub TM . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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“…Recommendations are based on evidence primarily from single-center randomized trials that test the effect of interventions in select CS patient cohorts not stratified for age, sex, race, location, or other inequities. 1 The ERAS CS protocol is favored because it has significantly reduced time frames for preoperative and intraoperative care, therefore total length of stay. The postoperative recovery interval has, however, been relatively consistent.…”

mentioning

confidence: 99%

“…An enhanced recovery after surgery (ERAS) protocol for cardiac surgery (CS) has been developed as a fast-track framework for patient management in this specialist practice domain. Recommendations are based on evidence primarily from single-center randomized trials that test the effect of interventions in select CS patient cohorts not stratified for age, sex, race, location, or other inequities 1 . The ERAS CS protocol is favored because it has significantly reduced time frames for preoperative and intraoperative care, therefore total length of stay.…”

mentioning

confidence: 99%

Multimodal Analgesic Effectiveness on Acute Postoperative Pain Management After Adult Cardiac Surgery

Wynne¹,

Fredericks²,

Hyde³

et al. 2023

J Cardiovasc Nurs

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Background Many patients report moderate to severe pain in the acute postoperative period. Enhanced recovery protocols recommend multimodal analgesics, but the optimal combination of these is unknown. Purpose The aim of this study was to synthesize the best available evidence about effectiveness of multimodal analgesics on pain after adult cardiac surgery. Methods A systematic review to determine the effect of multimodal postoperative analgesics is proposed (International Prospective Register of Systematic Reviews Registration CRD42022355834). Multiple databases including the Cochrane Library, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, American Psychological Association, the Education Resources Information Centre, the Excerpta Medica database, the Medical Literature Analysis and Retrieval System Online, Scopus, Web of Science, and clinical trials databases will be searched. Screening in Covidence and quality assessment will be conducted by 2 authors. A grading of recommendations, assessment, development, and evaluation summary of findings will be presented if meta-analysis is possible.

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Enhanced Recovery After Surgery Protocols May Help Reduce Racial and Socioeconomic Disparities in Cardiac Surgery

Cited by 14 publications

References 18 publications

The effect of socioeconomic factors on patient outcomes in cardiac surgery

The effect of socioeconomic factors on patient outcomes in cardiac surgery

Should We Rely on AI to Help Avoid Bias in Patient Selection for Major Surgery?

Multimodal Analgesic Effectiveness on Acute Postoperative Pain Management After Adult Cardiac Surgery

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