Enhanced Recovery Pathway Improves Colorectal Surgery Outcomes in Private and Safety-Net Settings.
J Surg Res
; 245: 354-359, 2020 01.
Article
em En
| MEDLINE
| ID: mdl-31425875
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 ANDMETHODS:
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.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Hospitais Privados
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Cirurgia Colorretal
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Procedimentos Clínicos
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Provedores de Redes de Segurança
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Recuperação Pós-Cirúrgica Melhorada
Tipo de estudo:
Guideline
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Observational_studies
Aspecto:
Determinantes_sociais_saude
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Equity_inequality
Limite:
Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
J Surg Res
Ano de publicação:
2020
Tipo de documento:
Article
País de publicação:
EEUU
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ESTADOS UNIDOS
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ESTADOS UNIDOS DA AMERICA
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EUA
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UNITED STATES
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UNITED STATES OF AMERICA
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US
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USA