The association of social vulnerability with colorectal enhanced recovery program failure.
The association of social vulnerability with colorectal enhanced recovery program failure.
复制标题
社会脆弱性与结直肠加速康复计划失败的关联。
DOI：
10.1016/j.sopen.2023.03.007
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发表时间：
2023
影响因子：
1.4
通讯作者：
Chu,DanielI
中科院分区：
文献类型：
--
作者：
Smith,BurkelyP;Hollis,RobertH;Shao,ConnieC;Gleason,Lauren;Wood,Lauren;McLeod,MarshallC;Kay,DanielleI;Oates,GabrielaR;Pisu,Maria;Chu,DanielI
背景强化康复计划（ERP）可以改善预后，但超过20%的患者ERP失败，社会脆弱性的贡献尚不清楚。本研究旨在描述社会脆弱性和ERP依从性和failure.MethodsThis之间的关联是一项回顾性队列研究的结直肠手术患者在2015年和2020年之间利用ACS-NSQIP数据。将ERP失败（LOS > 6天）的患者与ERP未失败的患者进行比较。结果1191例患者中有273例（22.9%）ERP失败。在ERP组件依从性> 70%的患者中，SVI是ERP失败的重要预测因子（OR 4.6，95%CI 1.3-16.8）。非依从性患者的SVI评分显著较高，有3个关键ERP组成部分：术前阻滞（0.58 vs. 0.51，p < 0.01），早期饮食（0.57 vs. 0.52，p = 0.04）和早期Foley切除（0.55对0.50，结论较高的社会脆弱性与3个关键ERP成分的不依从性以及依从性> 70%的人的ERP失败有关。ERP组件。社会脆弱性需要得到承认，解决，并包括在努力进一步改善ERPs.Key messageSocial脆弱性与不遵守增强恢复组件和ERP故障之间的高ERP坚持。在努力改善应急方案时，需要解决社会脆弱性问题。
BackgroundEnhanced recovery programs (ERPs) improve outcomes, but over 20 % of patients fail ERP and the contribution of social vulnerability is unknown. This study aimed to characterize the association between social vulnerability and ERP adherence and failure.MethodsThis was a retrospective cohort study of colorectal surgery patients between 2015 and 2020 utilizing ACS-NSQIP data. Patients who failed ERP (LOS > 6 days) were compared to patients not failing ERP. The CDC's social vulnerability index (SVI) was used to assess social vulnerability.Result273 of 1191 patients (22.9 %) failed ERP. SVI was a significant predictor of ERP failure (OR 4.6, 95 % CI 1.3–16.8) among those with >70 % ERP component adherence. SVI scores were significantly higher among patients non-adherent with 3 key ERP components: preoperative block (0.58 vs. 0.51, p < 0.01), early diet (0.57 vs. 0.52, p = 0.04) and early foley removal (0.55 vs. 0.50, p < 0.01).ConclusionsHigher social vulnerability was associated with non-adherence to 3 key ERP components as well as ERP failure among those who were adherent with >70 % of ERP components. Social vulnerability needs to be recognized, addressed, and included in efforts to further improve ERPs.Key messageSocial vulnerability is associated with non-adherence to enhanced recovery components and ERP failure among those with high ERP adherence. Social vulnerability needs to be addressed in efforts to improve ERPs.