The association of social vulnerability with colorectal enhanced recovery program failure

Burkely P. Smith, MD; Robert H. Hollis, MD, MSPH; Connie C. Shao, MD, MSPH; Lauren Gleason, MD; Lauren Wood, MPSH; Marshall C. McLeod, MS, PhD; Danielle I. Kay, MD; Gabriela R. Oates, PhD; Maria Pisu, PhD; Daniel I. Chu, MD, MSPH, FACS, FASCRS

Surgery Open Science (Jun 2023)

The association of social vulnerability with colorectal enhanced recovery program failure

Burkely P. Smith, MD,
Robert H. Hollis, MD, MSPH,
Connie C. Shao, MD, MSPH,
Lauren Gleason, MD,
Lauren Wood, MPSH,
Marshall C. McLeod, MS, PhD,
Danielle I. Kay, MD,
Gabriela R. Oates, PhD,
Maria Pisu, PhD,
Daniel I. Chu, MD, MSPH, FACS, FASCRS

Affiliations

Burkely P. Smith, MD: University of Alabama at Birmingham, Department of Surgery, Division of Gastrointestinal Surgery, BDB 581, 1720 2nd Avenue South, Birmingham, AL 35294, United States of America
Robert H. Hollis, MD, MSPH: University of Alabama at Birmingham, Department of Surgery, Division of Gastrointestinal Surgery, BDB 581, 1720 2nd Avenue South, Birmingham, AL 35294, United States of America
Connie C. Shao, MD, MSPH: University of Alabama at Birmingham, Department of Surgery, Division of Gastrointestinal Surgery, BDB 581, 1720 2nd Avenue South, Birmingham, AL 35294, United States of America
Lauren Gleason, MD: University of Alabama at Birmingham, Department of Surgery, Division of Gastrointestinal Surgery, BDB 581, 1720 2nd Avenue South, Birmingham, AL 35294, United States of America
Lauren Wood, MPSH: University of Alabama at Birmingham, Department of Surgery, Division of Gastrointestinal Surgery, BDB 581, 1720 2nd Avenue South, Birmingham, AL 35294, United States of America
Marshall C. McLeod, MS, PhD: University of Alabama at Birmingham, Department of Surgery, Division of Gastrointestinal Surgery, BDB 581, 1720 2nd Avenue South, Birmingham, AL 35294, United States of America
Danielle I. Kay, MD: University of Alabama at Birmingham, Department of Surgery, Division of Gastrointestinal Surgery, BDB 581, 1720 2nd Avenue South, Birmingham, AL 35294, United States of America
Gabriela R. Oates, PhD: University of Alabama at Birmingham, Department of Pediatrics, 1600 7th Ave S, Birmingham, AL 35233, United States of America
Maria Pisu, PhD: University of Alabama at Birmingham, Division of Preventive Medicine and O'Neal Comprehensive Cancer Center, 1808 7th Ave S, Birmingham, AL 35233, United States of America
Daniel I. Chu, MD, MSPH, FACS, FASCRS: University of Alabama at Birmingham, Department of Surgery, Division of Gastrointestinal Surgery, BDB 581, 1720 2nd Avenue South, Birmingham, AL 35294, United States of America; Corresponding author.

Journal volume & issue: Vol. 13
pp. 1 – 8

Abstract

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Background: Enhanced recovery programs (ERPs) improve outcomes, but over 20 % of patients fail ERP and the contribution of social vulnerability is unknown. This study aimed to characterize the association between social vulnerability and ERP adherence and failure. Methods: This was a retrospective cohort study of colorectal surgery patients between 2015 and 2020 utilizing ACS-NSQIP data. Patients who failed ERP (LOS > 6 days) were compared to patients not failing ERP. The CDC's social vulnerability index (SVI) was used to assess social vulnerability. Result: 273 of 1191 patients (22.9 %) failed ERP. SVI was a significant predictor of ERP failure (OR 4.6, 95 % CI 1.3–16.8) among those with >70 % ERP component adherence. SVI scores were significantly higher among patients non-adherent with 3 key ERP components: preoperative block (0.58 vs. 0.51, p 70 % of ERP components. Social vulnerability needs to be recognized, addressed, and included in efforts to further improve ERPs. Key message: Social vulnerability is associated with non-adherence to enhanced recovery components and ERP failure among those with high ERP adherence. Social vulnerability needs to be addressed in efforts to improve ERPs.

Published in Surgery Open Science

ISSN: 2589-8450 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: https://www.journals.elsevier.com/surgery-open-science/

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