Enhanced recovery program (ERP) for gastrointestinal (GI) cancer surgeries in rural and urban hospitals of Alabama and Mississippi.

43 Background: ERPs standardize surgical care leading to improvements in perioperative outcomes and have reduced surgical outcome disparities in some settings. The extent to which ERPs are applied across urban and rural settings is not known. We begin to address this gap for patients undergoing surgery for GI cancer (colorectal, pancreatic, and esophageal) in Alabama and Mississippi. Methods: The ASCENDS study conducted surveys of GI cancer patients (stage 1-3, diagnosed within 5 years), and abstracted hospital charts for a subset of respondents. Survey questions assessed self-reported adherence to 10 ERP components, and chart abstractions assessed hospital-based adherence to 11 components. Overall ERP adherence was defined as adherence to ≥70% of ERP components. Results: Of 559 survey respondents (mean age 63.2±12.0), 54.2% were women, 80.5% had colorectal,14.3% pancreatic, and 5.2% esophageal cancer, 92.3% from urban and 7.7% from rural hospitals. The 259 respondents with charts abstracted had similar characteristics (6.6% from rural hospitals). Overall ERP adherence was 6.4% for self-reported surveys, and 42.9% for hospital-based chart abstractions. The Table reports highest to lowest adherence to each component by surgery phase. Moreover, education/counseling about surgery was documented in 96.7% of charts, antiemetic prophylaxis pre or intraoperative in 97.9%, and normothermia in 59.6%. Nausea/vomiting medications after surgery was reported in 78.9% surveys. Conclusions: Overall ERP adherence in GI cancer patients from the Deep South was low but not uniformly across ERP components. Self-reported adherence may be subject to recall limitations. Future efforts should focus on barriers providers and patients face to achieving adherence to all ERP components. Phase ERP Component Reported in Survey % Reported ERP Component Documented in Medical Chart % Documented Preoperative Bowel prep with laxative products (e.g., miralax) (N=393) 82.1 Bowel prep: mechanical (N=136) 65.4 Bowel prep with antibiotics (e.g., flagyl) (N=370) 46.8 Preoperative oral antibiotics (N=153) 50.3 Carbohydrate loading: Sugary carbohydrate rich drink before surgery (N=455) 18.3 Clear liquids up to 2 hours before surgery (N=124) 98.4 Pain medication: Injection in back or side (N=422) 38.6 Pain medication: Preoperative block (spinal, TAP, etc.) (N=167) 52.1 DVT prophylaxis before surgery (N=385) 27.8 Preop VTE Chemoprophylaxis (N=142) 95.8 Postoperative No nasogastric tube (N=512) 83.4 No nasogastric tube (N=160) 76.3 Foley catheter removed within 3 days (N=363) 73.0 Foley catheter removed within 3 days (N=143) 83.9 Pain medication: Any (N=539)Pain medication: No opioids (N=408) 94.819.3 Pain control: Multimodal (preoperative block plus postoperative medications e.g., toradol) (N=159) 70.4 Denominators vary due to missing response or ineligibility.