Key result
Age >75, ASA 3-4, male sex, and ileostomy predict worse outcomes and fast-track protocol deviation.
Why the study?
What patient factors predict postoperative deviation from a fast-track colorectal surgery protocol and influence postoperative outcomes?
Cohort (n=606)
What patient factors predict postoperative deviation from a fast-track colorectal surgery protocol and influence postoperative outcomes?
Older age, higher ASA grade, and male sex are independent predictors of negative compliance to fast-track colorectal surgery protocols and worse postoperative outcomes.
High-risk patients may warrant caution with fast-track protocols; hypothesis-generating for tailored strategies pending randomized trials.
The aim of this prospective cohort study was to identify the patient factors that predict postoperative deviation from each item of a fast-track colorectal surgery protocol (FT) and these factors' influences on postoperative outcomes. A total of 606 patients with colorectal pathology from 2005 to 2011 were analyzed to assess the relationships between patient factors, the outcome variables, and the items of the FT program. The median length of stay was 5 days, and readmission rate was 2.3%. The morbidity rate was 26.7%. Independent predictors of prolonged length of stay were older than 75 years of age, ASA grade 3 and 4, and the presence of an ileostomy. Independent predictors of morbidity were age above 75 years old and ASA grade, whereas age was confirmed as an independent predictor of mortality. Male sex, age above 75 years old, and ASA 3 and 4 were identified as independent predictors of negative compliance to most of the postoperative FT items.
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Feroci et al. (2013) conducted a cohort in colorectal pathology (n=606). Patient factors (age >75 years, ASA grade 3-4, male sex, ileostomy) was evaluated on Postoperative deviation from fast-track protocol and postoperative outcomes (length of stay, morbidity, mortality). Age >75 years, ASA grade 3-4, male sex, and ileostomy independently predicted prolonged length of stay, morbidity (overall 26.7%), mortality, and negative compliance to fast-track protocol items.
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