择期结直肠手术后晚期恢复的决定因素

尽管采取了增强恢复方案，仍有相当比例的患者出现恢复延迟。识别延迟恢复的潜在决定因素对于优化围手术期方案和个性化患者路径至关重要。本研究旨在确定可能影响恢复的因素。采用回顾性观察性研究，基于2015年至2022年间专门收集的数据登记。涉及意大利22家专注于大容量结直肠手术且接受增强恢复方案培训的医院。研究对象为接受结直肠癌或良性疾病择期切除的患者。评估术后第2天的恢复状态，未能在该日满足至少两个术后恢复指标（口服喂养、导尿管拔除、静脉输液停止和活动能力恢复）定义为恢复延迟。共分析1535例患者，整体遵循术前和术中增强恢复措施的中位率为75.0%（范围：66.6%-83.3%）。其中，487例（31.7%）表现为恢复延迟。多元回归分析发现六项增强恢复措施与术后恢复显著正相关：术前咨询（调整比值比[aOR] 2.596）、术前糖水摄入（aOR 1.948）、术中液体输注<7 ml/kg/h（aOR 1.662）、避免胸腔硬膜外镇痛（aOR 2.137）、手术结束时拔除胃管（aOR 4.939）以及成功腹腔镜手术（aOR 2.341）。随着这些积极措施的遵循率增加，恢复延迟发生率逐步降低，达到全部措施实施时为13.0%（相关系数r=-0.99，p<0.001）。由于数据来自多中心、多患者的回顾性分析，存在一定限制。结论表明，遵循特定的术前和术中增强恢复措施，如提前咨询、术前糖水、限制液体、避免硬膜外、早期拔除胃管和成功腹腔镜，是促进择期结直肠切除术后早期恢复的关键。

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.