Enhanced Recovery after Surgery Protocol Compliance and Early Outcomes for Elective Colorectal Procedures by Race/Ethnicity and Socioeconomic Status

OBJECTIVE: To explore the association of socioeconomic status (SES) and race/ethnicity with perioperative metrics within the enhanced recovery after surgery framework to identify gaps for equity-informed improvements. BACKGROUND: Although enhanced recovery after surgery pathways improve perioperative outcomes through standardized care, disparities in protocol adherence and postoperative outcomes persist, particularly for vulnerable populations. METHODS: We conducted a retrospective cohort study using a single-institution database of elective colorectal surgeries (2018-2021). Patients were categorized and assessed by SES and race/ethnicity. RESULTS: Overall, 1519 patients were analyzed: 180 had low SES (11.8%) and 1339-high SES (88.2%). Low SES patients had lower rates of bowel preparation completion, use of the electronic patient portal, and carbohydrate-loading presurgery. Low SES was associated with a longer median length of stay (LOS; 4 vs 3 days, P < 0.001). Multivariate logistic regression analysis showed low SES was linked to higher odds of infection [odds ratio (OR): 2.46, 95% CI: 1.31-4.63] and all in-hospital complications (OR: 1.50, 95% CI: 1.06-2.12). Among racial/ethnic cohorts, Black patients had lower rates of documented preoperative patient education, longer median LOS (5 vs 3-4 days, P = 0.002), and increased odds of respiratory complications (OR: 4.11, 95% CI: 1.56-10.85). CONCLUSIONS: Low SES was linked to lower compliance with important process measures, higher infectious and all in-hospital complication rates, and longer LOS. Despite high rates of protocol compliance, Black race/ethnicity showed an association with increased odds of respiratory complications and extended LOS. Adjustments to perioperative protocols could address such disparities, helping to improve postoperative outcomes of colorectal surgeries.