Smith Burkely P, Hollis Robert H, Shao Connie C, Gleason Lauren, Wood Lauren, McLeod Marshall C, Kay Danielle I, Oates Gabriela R, Pisu Maria, Chu Daniel I
University of Alabama at Birmingham, Department of Surgery, Division of Gastrointestinal Surgery, BDB 581, 1720 2nd Avenue South, Birmingham, AL 35294, United States of America.
University of Alabama at Birmingham, Department of Pediatrics, 1600 7th Ave S, Birmingham, AL 35233, United States of America.
Surg Open Sci. 2023 Mar 23;13:1-8. doi: 10.1016/j.sopen.2023.03.007. eCollection 2023 Jun.
Enhanced 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.
This 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.
273 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).
Higher 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.
Social 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.
强化康复计划（ERPs）可改善治疗效果，但超过20%的患者在ERPs中失败，且社会脆弱性的作用尚不清楚。本研究旨在描述社会脆弱性与ERP依从性及失败之间的关联。
这是一项利用美国外科医师学会国家外科质量改进计划（ACS-NSQIP）数据对2015年至2020年间结直肠手术患者进行的回顾性队列研究。将ERP失败（住院时间>6天）的患者与未失败的患者进行比较。采用美国疾病控制与预防中心（CDC）的社会脆弱性指数（SVI）评估社会脆弱性。
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失败的显著预测因素（比值比4.6，95%置信区间1.3-16.8）。在不依从3个关键ERP组件的患者中，SVI得分显著更高：术前阻滞（0.58对0.51，p<0.01）、早期饮食（0.57对0.52，p=0.04）和早期拔除导尿管（0.55对0.50，p<0.01）。
较高的社会脆弱性与不依从3个关键ERP组件以及在ERP组件依从性>70%的患者中ERP失败相关。社会脆弱性需要得到认识、解决，并纳入进一步改善ERPs的努力中。
社会脆弱性与高ERP依从性患者不依从强化康复组件及ERP失败相关。在改善ERPs的努力中需要解决社会脆弱性问题。
