{
    "abstract": "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.\nA 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.\nThe 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)].\nImplementation 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.",
    "authors": [
        {
            "affiliation": "Department of Anesthesiology, NewYork-Presbyterian, Weill Cornell, New York, NY, USA.",
            "firstname": "A T",
            "initials": "AT",
            "lastname": "Gilman"
        },
        {
            "affiliation": "Department of Population Health Sciences, NewYork-Presbyterian, Weill Cornell, New York, NY, USA.",
            "firstname": "J",
            "initials": "J",
            "lastname": "Kim"
        },
        {
            "affiliation": "Department of Anesthesiology, NewYork-Presbyterian, Weill Cornell, New York, NY, USA.",
            "firstname": "S Y",
            "initials": "SY",
            "lastname": "Jiang"
        },
        {
            "affiliation": "Department of Anesthesiology, NewYork-Presbyterian, Weill Cornell, New York, NY, USA.",
            "firstname": "S E",
            "initials": "SE",
            "lastname": "Abramovitz"
        },
        {
            "affiliation": "Department of Anesthesiology, NewYork-Presbyterian, Weill Cornell, New York, NY, USA. Electronic address: rsw9006@med.cornell.edu.",
            "firstname": "R S",
            "initials": "RS",
            "lastname": "White"
        }
    ],
    "conclusions": "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.",
    "copyrights": "Copyright \u00a9 2025 Elsevier Ltd. All rights reserved.",
    "doi": "10.1016/j.ijoa.2025.104362",
    "journal": "International journal of obstetric anesthesia",
    "keywords": [
        "Cesarean delivery",
        "Enhanced recovery after surgery",
        "Healthcare disparities",
        "Maternal health",
        "Obstetric",
        "Outcomes",
        "Severe maternal morbidity",
        "Social determinants of health"
    ],
    "methods": null,
    "publication_date": "2025-04-06",
    "pubmed_id": "40187037",
    "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)].",
    "title": "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 NYC hospitals (2016-2020).",
    "xml": "<Element 'PubmedArticle' at 0x788505c47650>"
}