Racial Disparity in Length of Stay Following Implementation of a Bariatric Enhanced Recovery Program.

Area of Science:

• Bariatric Surgery Outcomes
• Health Disparities Research
• Enhanced Recovery Programs

Background:

• Enhanced Recovery Programs (ERPs) are known to reduce racial disparities in postoperative length of stay (LOS) for colorectal surgery patients.
• The impact of ERPs on LOS racial disparities in the bariatric surgery population remains under investigation.

Purpose of the Study:

• To evaluate racial disparities in LOS for bariatric surgery patients before and after the implementation of an ERP.
• To determine if ERPs effectively reduce LOS disparities between Black and White patients undergoing bariatric surgery.

Main Methods:

• A retrospective cohort study analyzed data from patients undergoing minimally invasive sleeve gastrectomy or Roux-en-Y gastric bypass.
• Patient data from pre-ERP (2017-2019) and ERP (2020-2022) eras were compared.
• Statistical analyses included Chi-square, Kruskal-Wallis, ANOVA, and multivariable regression to assess LOS.

Main Results:

• The study included 764 patients (363 pre-ERP, 401 ERP), with similar demographics across cohorts.
• Overall median LOS decreased significantly from 2 days pre-ERP to 1 day post-ERP (P < 0.001).
• While LOS decreased for both Black and White patients, Black patients continued to have a longer estimated LOS (eLOS) than White patients (eLOS 0.21 days, P = 0.01).

Conclusions:

• Bariatric surgery ERP implementation is associated with reduced LOS for all patients.
• Despite ERPs, a disparity in LOS persists, with Black patients experiencing longer stays than White patients.
• Further research is necessary to identify and address the underlying mechanisms driving these persistent racial disparities in LOS.