尽管实施了加速康复方案，但仍有很大一部分患者康复延迟。确定延迟恢复的潜在决定因素对于优化围手术期方案和定制患者路径至关重要。本研究旨在确定延迟恢复的可能决定因素。回顾性观察研究基于前瞻性收集的 2015 年至 2022 年的专用登记册。22 家意大利医院专门针对接受大容量结直肠手术并接受加速康复方案培训。因癌症或良性疾病接受择期结直肠切除术的患者。术后第 2 天的恢复状态。晚期恢复定义为未能满足至少两项术后恢复指标（口服喂养）术后第 2 天，拔除导尿管、停止静脉输液和活动）。总共对 1535 名患者进行了分析。术前和术中加速康复方案项目的中位总体依从率为 75.0%（范围：66.6%-83.3%）。 487 名 (31.7%) 患者出现恢复延迟。多元回归分析显示，加速康复方案的六个项目对术后恢复独立产生积极影响：入院前咨询（调整后比值比 [aOR] 2.596）、术前碳水化合物饮料（aOR 1.948）、术中液体输注 < 7 ml/kg/h（ aOR 1.662），避免胸段硬膜外镇痛（aOR 2.137），手术结束时拔除鼻胃管（aOR 4.939），以及成功的腹腔镜检查（aOR 2.341）。随着对这六项积极项目的坚持增加，延迟恢复率逐渐下降，当应用所有项目时，延迟恢复率达到 13.0%（相关系数 [r] = - 0.99，p < 0.001）。这项研究因其对登记册的回顾性分析而受到限制。包含来自多个中心和不同患者群体的数据。遵守特定的术前和术中加速康复方案项目，包括咨询、术前碳水化合物摄入、限制性术中液体管理、避免胸段硬膜外镇痛、早期拔除鼻胃管和成功腹腔镜检查，对于促进选择性结直肠切除术后的早期恢复似乎至关重要。© 2024。Springer Nature Switzerland AG。

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.© 2024. Springer Nature Switzerland AG.