Achieving Health Equity: Advancing Colorectal Surgery among Racial and Ethnic Minorities in America.

Racial inequities in short and long-term outcomes following colorectal surgery continue to persist. Using inflammatory bowel disease and colorectal cancer as disease foci, we review existing racial inequities in surgical outcomes and complications, discuss how social determinants of health and biopsychosocial factors can contribute to these inequities, and highlight potential mechanisms for building interventions to achieve health equity following colorectal surgery for minority populations.

Expedited discharge and risk of readmission after ostomy construction.

Background: Expedited discharge after surgery with construction of an ostomy may leave patients less prepared for home self-care, leading to increased hospital readmissions. We evaluated whether readmission rates were greater for patients with an expedited discharge (1-2 days) compared with nonexpedited discharge (3-5 days) after ostomy construction.

Methods: A retrospective analysis of a prospective database of patients undergoing ostomy construction was performed using the American College of Surgeons National Safety and Quality Improvement Project data between years 2019 and 2020.

Management of Localized and Locally Advanced Anal Cancer.

The initial evaluation and workup of anal canal cancer and perianal cancer is the same, but treatment strategies differ based on stage and location of disease. Chemoradiation remains the cornerstone of treatment for anal canal squamous cell carcinoma (SCC), while surgery is typically reserved for persistent or recurrent disease. Perianal SCC can be treated with local excision for early stage disease (T1N0, select T2N0) or chemoradiation for later stages.

Socioecological Determinants of Health and the Quality of Colonoscopy in Rural Alabama.

Background: Rural patients experience a higher incidence of and mortality from colorectal cancer. Ensuring high-quality screening is essential to address these disparities.

Objective: To investigate whether socioecological determinants of health are associated with colonoscopy quality in rural Alabama.

Novel Characterization of Socioecological Determinants of Health in Rural Alabama.

Introduction: Socioecological determinants of health (SEDOHs) influence disparities in surgical outcomes. However, SEDOHs are challenging to measure, limiting our ability to address disparities. Using a validated survey (SEDOH-88), we assessed SEDOHs in three rural communities in Alabama.

Can screen-time help? An analysis of usage of patient engagement technology following colorectal surgery.

Background: Patient engagement technologies (PETs) guide patients through the perioperative period. We aimed to investigate the levels of patient engagement with PETs through the peri-operative period and its impact on clinical outcomes.

Methods: Retrospective cohort study of patients undergoing elective colorectal surgery from 2018 to 2022.

Development of a comprehensive survey to assess key socioecological determinants of health.

Background: Although disparities in surgical outcomes are well-documented, our understanding of how socioecological factors drive these disparities remains limited. Comprehensive and efficient assessment tools are needed. This study's objective was to develop and assess the acceptability and feasibility of a comprehensive tool evaluating socioecological determinants of health in patients requiring colorectal surgery.

Understanding the Impact of Enhanced Recovery Programs on Social Vulnerability, Race, and Colorectal Surgery Outcomes.

Background: Increasing social vulnerability, measured by the Social Vulnerability Index, has been associated with worse surgical outcomes. However, less is known about the impact of social vulnerability on patients who underwent colorectal surgery under enhanced recovery programs.

Objective: We hypothesized that increasing social vulnerability is associated with worse outcomes before enhanced recovery implementation, but that after implementation, disparities in outcomes would be reduced.

Racial Differences in Aging-Related Deficits Among Older Adults With Colorectal Cancer.

Background: Despite the known influences of both race- and aging-related factors in colorectal cancer outcomes and mortality, limited literature is available on the intersection between race and aging-related impairments.

Objective: To explore racial differences in frailty and geriatric deficit subdomains among patients with colorectal cancer.

Design: Retrospective study using data from the Cancer and Aging Resilience Evaluation registry.

Racial disparities in postoperative outcomes persist 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.

A socioecological qualitative analysis of barriers to care in colorectal surgery.

Background: Although specific social determinants of health have been associated with disparities in surgical outcomes, there exists a gap in knowledge regarding the mechanisms of these associations. Gaining perspectives from multiple socioecological levels can help elucidate these mechanisms. Our study aims to identify social determinants of health that act as barriers or facilitators to surgical care among colorectal surgery stakeholders.

The association of social vulnerability with colorectal enhanced recovery program failure.

Background: Enhanced recovery programs (ERPs) improve outcomes, but over 20 % of patients fail ERP and the contribution of social vulnerability is unknown. This study aimed to characterize the association between social vulnerability and ERP adherence and failure.

Methods: This was a retrospective cohort study of colorectal surgery patients between 2015 and 2020 utilizing ACS-NSQIP data.

Improving surgical patient education materials using informational design with visual elements.

Patient education materials (PEMs) serve as a foundation for educating patients and families across all surgical fields but are often not understandable. The National Institute of Health (NIH) recommends that PEMs be written at a grade 6-7 reading level; however, most current materials exceed that measure. Lack of understandable and appropriate surgical PEMs compounds the difficulties that low health literacy patients face with resultant poor surgical outcomes.

Healthcare Disparities and Colorectal Cancer.

Health care disparities are defined as health differences between groups that are avoidable, unnecessary, and unjust. Racial disparities in colorectal cancer mortality, particularly for Black patients, are well-described. Disparities in preventative measures, early detection, effective treatment, and posttreatment services contribute to these differences.

Multidisciplinary clinics for colorectal cancer may not provide more efficient coordination of care.

Background: This retrospective study compares a multidisciplinary clinic (MDC) to standard care for time to treatment of colorectal cancer.

Methods: We queried our institutional ACS-NSQIP database for patients undergoing surgery for colorectal cancer from 2017 to 2020. Patients were stratified by initial clinic visit (MDC vs control).

Small Bowel Crohn's Disease Recurrence is Common After Total Proctocolectomy for Crohn's Colitis.

Background: Surgical intervention for Crohn's disease involving the colon is often a total proctocolectomy with end ileostomy. There are limited data regarding postoperative small bowel recurrence rates in the recent era.

Objective: The purpose of this study was to determine the rate of small bowel Crohn's disease recurrence following total proctocolectomy and secondarily define risk factors for disease recurrence.

Racial disparities exist in surgical outcomes for patients with inflammatory bowel disease.

Background: Racial disparities in surgical outcomes exist for Black patients with IBD compared to White patients. However, previous studies fail to include other racial/ethnic populations. We hypothesized these disparities exist for Hispanic and Asian patients.

The impact of an enhanced recovery program (ERP) on the costs of colorectal surgery.

Background: Enhanced Recovery Programs (ERPs) benefit patients but their effects on healthcare costs remain unclear. This study aimed to investigate the costs associated with a colorectal ERP in a large academic health system.

Methods: Patients who underwent colorectal surgery from 2012 to 2014 (pre-ERP) and 2015-2017 (ERP) were propensity score matched based on patient and operative-level characteristics.

Emotional Intelligence and Burnout in Surgical Residents: A 5-Year Study.

Objective: We sought to characterize the interactions of burnout with internal and external factors over the past 5 years for surgery residents at our institution. We hypothesized that burnout levels would be consistent among years, inversely related to emotional intelligence (EI) and job resources, and directly related to disruptive behaviors.

Design: General surgery residents at a single institution were invited to complete a survey each year from 2015 to 2019 that included a combination of the 22-item Maslach-Burnout Inventory, 30-item trait EI questionnaire, as well as focused questions assessing disruptive behaviors (8 items), job resources (8 items), and demographic characteristics.

Postoperative Complications After Colorectal Surgery: Where Are We in the Era of Enhanced Recovery?

Purpose Of Review: Individual elements in enhanced recovery pathways may be associated with specific complication risks. In this review, we highlight three areas of controversy surrounding complications in enhanced recovery: (1) whether enhanced recovery is associated with increased rates of acute kidney injury, (2) whether NSAID use is associated with anastomotic leaks, and (3) whether early urinary catheter removal is justified following colorectal surgery.

Recent Findings: Acute kidney injury has been reported at several institutions following implementation of enhanced recovery pathways highlighting the importance of institutional data tracking.

Understanding the Surgical Experience for African-Americans and Caucasians With Enhanced Recovery.

Introduction: Racial/ethnic disparities in surgical outcomes exist. Enhanced recovery programs (ERPs) have reduced some racial/ethnic disparities, but it remains unclear if disparities in experiences are also reduced. The purpose of this study was to use qualitative methods to better understand the surgical experience for African-American and Caucasian patients in the setting of an ERP.