选修结直肠手术后迟到的决定因素

尽管实施了增强的恢复方案，但很大一部分患者的恢复延迟。 Identifying potential determinants of delayed recovery is crucial for optimizing perioperative protocols and tailoring patient pathways.This study aims to identify possible determinants of delayed recovery.Retrospective observational study based on a prospectively collected dedicated register spanning from 2015 to 2022.Twenty-two Italian hospitals specializing in high-volume colorectal surgery and trained in enhanced recovery protocols.Patients undergoing elective癌症或良性疾病的结直肠切除术。术后第2天的记录状态。晚期恢复被定义为未能满足术后恢复至少两个指标（口服喂养，尿液导管的去除，静脉输液液的停止，动员和动员）在术后2.a术。术前和术中增强恢复方案项目的总体依从性中位数为75.0％（范围：66.6％-83.3％）。在487例（31.7％）患者中观察到延迟恢复。 Multiple regression analysis revealed six enhanced recovery protocol items that independently positively influenced postoperative recovery: pre-admission counseling (adjusted odds ratio [aOR] 2.596), a preoperative carbohydrate drink (aOR 1.948), intraoperative fluid infusions < 7 ml/kg/h (aOR 1.662), avoidance of thoracic epidural analgesia (aOR 2.137),在手术结束时（AOR 4.939）和成功的腹腔镜检查（AOR 2.341），去除鼻腔管（AOR 4.939）。随着对这六个积极项目的依从性的增加，恢复的延迟率逐渐降低，当应用所有项目时，相关系数[r] = -0.99，p <0.001）达到13.0％。这项研究受到回顾性分析的限制，其对寄存器的回顾性分析限制了对多个中心的登记册中的登记册，并在多个中心和一个多样性的求职者中培养了恢复性的恢复性，并恢复了恢复性，并将其用于恢复性恢复性，并将其用于恢复性恢复性，并将其用于恢复性，并将其用于恢复性，并将其用于恢复性，并将其用于恢复性，并将其用于恢复性，并将其纳入恢复性的培训，并将其纳入寄存器。摄入，限制性术中液体管理，避免胸硬膜外镇痛，早期去除鼻腔管以及成功的腹腔镜检查对于促进攻击性结肠直肠切除后促进早期恢复至关重要。

Despite the implementation of enhanced recovery protocols, a significant proportion of patients experience delayed recovery. Identifying potential determinants of delayed recovery is crucial for optimizing perioperative protocols and tailoring patient pathways.This study aims to identify possible determinants of delayed recovery.Retrospective observational study based on a prospectively collected dedicated register spanning from 2015 to 2022.Twenty-two Italian hospitals specializing in high-volume colorectal surgery and trained in enhanced recovery protocols.Patients undergoing elective colorectal resection for cancer or benign disease.Recovery status on postoperative day 2. Late recovery was defined as the failure to meet at least two indicators of postoperative recovery (oral feeding, removal of the urinary catheter, cessation of intravenous fluids, and mobilization) on postoperative day 2.A total of 1535 patients were analyzed. The median overall adherence to pre- and intraoperative enhanced recovery protocol items was 75.0% (range: 66.6%-83.3%). Delayed recovery was observed in 487 (31.7%) patients. Multiple regression analysis revealed six enhanced recovery protocol items that independently positively influenced postoperative recovery: pre-admission counseling (adjusted odds ratio [aOR] 2.596), a preoperative carbohydrate drink (aOR 1.948), intraoperative fluid infusions < 7 ml/kg/h (aOR 1.662), avoidance of thoracic epidural analgesia (aOR 2.137), removal of nasogastric tube at the end of surgery (aOR 4.939), and successful laparoscopy (aOR 2.341). The rate of delayed recovery progressively decreased with increasing adherence to these six positive items, reaching 13.0% when all items were applied (correlation coefficient [r] = - 0.99, p < 0.001).This study is limited by its retrospective analysis of a register containing data from multiple centers and a diverse patient population.Adherence to specific pre- and intraoperative enhanced recovery protocol items, including counseling, preoperative carbohydrate intake, restrictive intraoperative fluid management, avoidance of thoracic epidural analgesia, early removal of nasogastric tube, and successful laparoscopy, appears crucial for promoting early recovery following elective colorectal resection.