Enhanced recovery protocols are falling short for low socioeconomic and minority patients, highlighting critical gaps in care.

• Low socioeconomic status (SES) linked to a 4-day median length of stay vs. 3 days for high SES (p < 0.001).
• Low SES associated with 2.46 times higher odds of infection and 1.50 times higher odds of overall complications.

Improving protocol adherence and tailored preoperative education could enhance outcomes.

• Black patients faced a 5-day median length of stay and had 4.11 times higher odds of respiratory complications.