Racial health disparities in severe maternal morbidity before and after implementation of an enhanced recovery after cesarean delivery protocol: a retrospective observational study at two New York City hospitals (2016-2020).

BACKGROUND

Enhanced recovery after cesarean delivery (ERAC) is an evidence-based pathway that aims to improve the quality of care for all patients. Standardization of care has been seen as a tool to promote equality and equity. Our goal was to evaluate racial differences in severe maternal morbidity (SMM) among patients before and after implementation of an ERAC program.

METHODS

A retrospective study was performed among cesarean delivery patients pre- and post-ERAC implementation at two large academic hospitals in New York City from October 2016 to September 2020. Logistic regression models were created to compare peripartum SMM complications pre-ERAC, post-ERAC, and overall, by race.

RESULTS

The sample consisted of 7,812 cesarean delivery patients, of which 4,640 were pre-ERAC (59.4%) and 3172 were post-ERAC (40.6%). Within the overall population, Black (aOR 1.57, 95% CI 1.07 to 2.28; P=0.018) and Asian (aOR 1.61, 95% CI 1.20 to 2.14; P=0.001) patients had higher odds of SMM compared to white patients. Pre-ERAC, Black (aOR 1.92, 95% CI 1.16 to 3.14; P=0.010) and Asian patients (aOR 1.86, 95% CI 1.26 to 2.74; P=0.002) had higher odds of SMM relative to white patients. Post-ERAC, this relationship was no longer statistically significant [Black (aOR 1.13, 95% CI 0.61 to 2.01; P=0.69) and Asian (aOR 1.39, 95% CI 0.88 to 2.17; P=0.15)].

CONCLUSION

Implementation of the ERAC protocol improved SMM outcomes by race. Standardization of practices in ERAC protocols can help address disparities by reducing variations in obstetrical care.