Racial Disparity in Postoperative Outcomes Persists for Patients with Inflammatory Bowel Disease under a Colorectal Enhanced Recovery Program

Introduction Enhanced recovery programs (ERPs) reduce racial disparities in surgical outcomes for general colorectal surgery populations. It is unclear, however, if disparities in IBD populations are impacted by ERPs. Methods Retrospective study comparing IBD patients undergoing major elective colorectal operations before (2006–2014) and after (2015–2021) ERP implementation using ACS-NSQIP data. The primary outcome of length of stay (LOS) was analyzed by negative binomial regression, and secondary outcomes (complications and readmissions) by logistic regression. Results Of 466 IBD patients, 47% were pre-ERP and 53% were ERP patients. In multivariable analysis stratified by ERP period, Black race was associated with increased odds of complications in the pre-ERP (OR 3.6, 95%CI 1.4–9.3) and ERP groups (OR 3.1 95%CI 1.3–7.6). Race was not a predictor of LOS or readmission in either group. High social vulnerability was associated with increased odds of readmission pre-ERP (OR 15.1, 95%CI 2.1–136.3), but this disparity was mitigated under ERPs (OR 1.4, 95%CI 0.4–5.6). Conclusion While ERPs mitigated some disparities by social vulnerability, racial disparities persist in IBD populations even under ERPs. Further work is needed to achieve surgical equity for IBD patients.