Determinants of late recovery following elective colorectal surgery. Late recovery within ERAS pathway

Determinants of late recovery following elective colorectal surgery. Late recovery within ERAS pathway | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Determinants of late recovery following elective colorectal surgery. Late recovery within ERAS pathway Marco Ceresoli, Lorenzo Ripamonti, Corrado Pedrazzani, Luca Pellegrino, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3975177/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 24 Sep, 2024 Read the published version in Techniques in Coloproctology → Version 1 posted 7 You are reading this latest preprint version Abstract Background. Despite the application of enhanced recovery protocol a considerable proportion of patients has a late recovery. The identification of possible determinants of late recovery might be crucial to implement perioperative protocols and to plan tailored pathways. Objective. The aim of this study is to identify possible determinants of late recovery. Design. Retrospective observational study based on a prospectively collected dedicated register. Setting. 22 Italian hospital with high volume colorectal surgery and trained in enhanced recovery protocols. Patients. Patients with elective colorectal resection for cancer of benign disease. Main outcome measures . Recovery on postoperative day two. Results. A total of 1536 patients were included in the analysis. The overall median adherence to preoperative and intraoperative enhanced recovery protocols item was 75.0% (66.6%- 83.3%). A late recovery was observed in 488 (31.8%) patients. Multiple regression analysis showed that six enhanced recovery protocols items had an independent positive impact on postoperative recovery: pre-admission counseling (OR 2.596), preoperative carbohydrate drink (OR 1.948), intraoperative fluid infusions <7mL/kg/h (OR 1.662), avoiding thoracic epidural analgesia(OR 2.137), removal of naso-gastric tube at the end of surgery (OR 4.939) and successful laparoscopy (OR 2.341). The late recovery rate progressively declined with the increasing adherence to these six positive items reaching 13.0% when all the items were applied (r= -0.99 p<0.001). Limitations. Retrospective analysis of a register including data from many different centers and the large case mix of patients. Conclusions : The implementation of identified items by the multiprofessional staff seems crucial to enhance the short-term recovery following colorectal surgery. Late recovery enhanced recovery protocol ERAS colorectal surgery Figures Figure 1 Figure 2 INTRODUCTION A fast recovery after colorectal surgery is the result of a multifactorial and multidisciplinary perioperative pathway focused on reducing surgical stress 1–3 . The implementation of enhanced recovery protocols (ERP) improved short-term outcome and reduced health care costs also in elderly and frail patients 4–7 . However, recent studies reported that a proportion of 25–30% of patients who underwent colorectal resection showed a late postoperative recovery 6–8 . A close relationship between a late recovery and overall morbidity has been reported 9–11 . A late recovery after colorectal surgery could be associated to several factors such as: patient's age and comorbidities, suboptimal adherence to perioperative ERP, exuberant postoperative inflammatory response, and incoming complications. The identification of possible determinants of late recovery might be crucial to implement perioperative protocols and to plan tailored pathways, particularly in high-risk patients. The aim of this study is to identify possible determinants of late recovery in a large series of patients undergoing colorectal surgery. MATERIALS AND METHODS The present study is reported according to the STROBE guidelines for the conducting and reporting of observational cohort studies 12 . We reviewed a prospectively collected database including patients undergoing elective colorectal surgery, in 22 Italian hospitals affiliated with the PeriOperative Italian Society. All hospitals treated patients within an extensive ERP according to international guidelines 13 . Collected data included demographics, patient comorbidities, preoperative and intraoperative parameters, surgical technique, adherence to preoperative/intraoperative ERP items, postoperative recovery indicators, and short-term outcome variables. All patients were given intravenous short-term antibiotic and deep venous thrombosis prophylaxes according to ERP recommendations 13 . High adherence to preoperative / intraoperative protocol was defined when more than 80% of items were applied 14 . The same day of surgery patients were mobilized out of bed and were allowed to take liquids by mouth at will. Removal of urinary catheter and starting of oral feeding were planned on postoperative day (POD) 1. Intravenous fluid infusion was stopped as early as possible according to oral feeding recovery. Indicators of postoperative recovery were oral feeding, urinary catheter removal, intravenous fluids stop, and mobilization assessed on POD 2. Late recovery was defined as the failure to meet at least two indicators on POD 2 6,8 . Criteria to identify postoperative complications were a priori defined and complications were graded according to Clavien-Dindo classification 15 . Complications graded as III to V were considered as major. Discharge criteria were no clinical or laboratory evidence of postoperative complications, good pain control with oral analgesics, adequate oral food intake with no need for intravenous fluids, recovered mobilization, and recovery of bowel function defined as passage of flatus. Post-operative follow-up was carried out for 30 days after hospital discharge. Hospital readmission for any postoperative complication occurring within 30 days after discharge was also recorded. Statistics Continuous variables were reported as median (Interquartile range) while categorical variables were reported as number (percentage). Univariate analysis was carried out to identify predictive variables for postoperative compliance. Significant (p < 0.05) variables associated with postoperative compliance at the univariate analysis were used to run a logistic multivariate regression model. Statistics were performed with SPSS 25 (IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp) RESULTS A total of 1850 patients undergoing elective colorectal resection were collected. After the exclusion of 314 patients with missing data a total of 1536 patients were included in the analysis. Table 1 shows the characteristics of the patients. Median age was 70 (61–78),1322 (86.1%) patients underwent surgery for cancer, 503 (32.8%) patients were ASA 3 or 4, and 1177 (76.7%) patients underwent laparoscopic surgery. Table 1 Patients characteristics. N % Median(IQR) Age 70 (61–78) Gender M 832 54.1% F 703 45.8% BMI 25 (22–27) Weight loss > 5% 19 1.2% MUST § score > 1 208 13.6% ASA score 1 177 11.5% 2 854 55.7% 3 449 29.3% 4 54 3.5% Diabetes 192 12.5% Preoperative Hb (mg/dL) 13 ( 11 – 14 ) Hb > 12 g/dL 983 67.8% Cancer 1322 86.1% Neoadjuvant CT/RT 124 8.1% Surgery duration > 180 min 876 57.4% Rectal surgery 387 25.2% Operative vasoactive drugs 74 4.8% Diverting stoma 265 17.3% § Malnutrition Universal Screening Tool Figure 1 shows the adherence to each preoperative and intraoperative ERP item. The overall median adherence was 75.0% (66.6%- 83.3%). The highest adherence was found for active warming and preoperative counselling, while the lowest for avoiding abdominal drain. A late recovery was observed in 488 (31.8%) patients of the overall series, in 295 (30.6%) subjects when considering the subgroup of uneventful patients, and in 180 (26.7%) patients of the subgroup with high adherence to preoperative / intraoperative protocol. Short-term postoperative outcome is reported in Table 2 . Overall 30-day morbidity was 24.7% (379 patients) and major complications occurred in 55 (3.6%) patients. Median length of stay was 6 ( 5 – 8 ) days, Readmission was recorded in 34 (2.2%) patients. Table 2 Short-term postoperative outcomes N % Median(IQR) Overall 30-day Morbidity 379 24.7% Major complication 55 3.6% Clavien-Dindo I 215 14.0% II 135 8.8% IIIa 26 1.7% IIIb 46 3.0% IVa 6 0.4% IVb 3 0.2% Anastomotic leak 45 2.9% Respiratory complication 44 2.9% SSI § 47 3.1% Urinary tract infection 31 2.0% Reoperation 53 3.5% Length of hospital stay 6 ( 5 – 9 ) Readmission 34 2.2% § Surgical Site Infection Multiple regression analysis showed that long duration of surgery (OR 0.548), diverting stoma (0.289), and postoperative morbidity (OR 0.458) were associated to late recovery (Table 3 ). Six ERP items had an independent positive impact on postoperative recovery (positive items): pre-admission counseling (OR 2.596), preoperative carbohydrate (CHO) drink (OR 1.948), intraoperative fluid infusions < 7mL/kg/h (OR 1.662), avoiding thoracic epidural analgesia (OR 2.137), removal of naso-gastric tube (NGT) at the end of surgery (OR 4.939), and successful laparoscopy (OR 2.341). Table 3. Univariate and multiple regression analysis. Univariate Multivariate OR 95% C.I. Sign. OR 95% C.I. Sign. Lower Upper Lower Upper Age 0.981 0.971 0.990 0.000 0.991 0.978 1.003 0.135 Men 1.089 0.877 1.352 0.439 BMI 0.992 0.967 1.018 0.560 Weight loss > 5% 0.413 0.167 1.024 0.056 MUST score 0.892 0.761 1.046 0.159 ASA > 2 0.649 0.518 0.813 0.000 0.858 0.633 1.163 0.323 Diabetes 0.692 0.506 0.946 0.021 1.070 0.709 1.615 0.747 Hb > 12 mg/dL 1.283 1.017 1.620 0.036 1.384 0.910 1.870 0.054 Cancer 0.904 0.660 1.238 0.528 Neoadjuvant CT/RT 0.666 0.257 1.169 0.094 1.745 1.011 3.013 0.056 Surgery duration > 180 min 0.561 0.448 0.702 <0.001 0.548 0.402 0.746 0.000 Rectal surgery 0.558 0.440 0.709 <0.001 0.947 0.630 1.424 0.793 Vasoactive drugs 0.671 0.416 1.081 0.101 Diverting stoma 0.293 0.224 0.385 0.000 0.289 0.182 0.459 0.000 30-day morbidity 0.334 0.262 0.425 0.000 0.458 0.341 0.615 0.000 Enhanced Recovery Protocol Items Counselling 3.019 1.961 4.650 0.000 2.596 1.505 4.478 0.001 No mechanical oral bowel preparation 0.968 0.713 1.314 0.835 Preop. CHO load 1.610 1.292 2.005 0.000 1.948 1.461 2.597 0.000 No premedication 0.842 0.677 1.047 0.121 Infusions < 7ml/Kg/h 1.328 1. 061 1.661 0.013 1.662 1.256 2.200 0.000 Balanced anesthesia 0.977 0.388 1.526 0.077 No thoracic epidural analgesia 1.586 1.264 1.991 <0.001 2.137 1.583 2.884 0.000 Active warming 0.743 0.330 1.673 0.473 PONV* prophylaxis 0.988 0.482 1.453 0.106 Successful laparoscopy 3.214 2.515 4.107 0.000 2.341 1.738 3.153 0.000 No Drain 0.637 0.500 0.812 0.000 1.094 0.806 1.483 0.564 Naso-gastric tube removal (end of surgery) 6.426 4.332 9.527 <0.001 4.939 3.003 8.124 0.000 § Malnutrition Universal Screening Tool * post operative nausea and vomiting Figure 2 shows that the late recovery rate progressively declined with the increasing adherence to the six positive items reaching 13.0% when all the items were applied (r= -0.99 p < 0.001). DISCUSSION The present study demonstrated that a late recovery following colorectal surgery occurred in about one third of patients. Long duration of surgery, diverting stoma and postoperative morbidity were significantly associated to late recovery, whereas pre-admission counseling, preoperative CHO drink, avoiding thoracic epidural analgesia, intraoperative fluid infusions < 7mL/Kg/h, removal of NGT at the end of surgery, and successful laparoscopy were associated with fast recovery. In the subgroup of patients who met all the six positive items the late recovery rate was 13%. Previous studies showed that advanced age and comorbidities, fluid overload, diverting stoma, suboptimal pain control, and exuberant inflammatory response were possible determinants of early postoperative low compliance to enhanced recovery protocols 6,8 . Moreover, early low compliance could be an indicator of incoming complications and was associated to higher overall morbidity following colorectal surgery 6 . The relationship between the adherence to preoperative/intraoperative protocol and compliance to postoperative pathway is a very important issue. Adherence which identifies the ERP items application is related to the protocol implementation by the multiprofessional team. Patient’s compliance to postoperative pathway should be considered as the result of ERP implementation and directly impacts on recovery. Therefore, the fast recovery after surgery may reflect the effectiveness of preoperative / intraoperative pathway 16 . In the present study the impact of preoperative / intraoperative items adherence on postoperative recovery has been evaluated. In our series, the proportion of patients with a late recovery was about 30%. In the subgroup of patients with high adherence to preoperative / intraoperative protocol the late recovery rate remained comparable. For this reason we explored the impact of each ERP item on postoperative recovery. The multiple regression analysis allowed to identify six ERP items with a positive impact on postoperative recovery. Some items had a suboptimal adherence and therefore should be implemented. Among these the goal directed fluid therapy is one of the most important determinants of GI function recovery 9,10,17–19 . To avoid the risk of fluid overload an intraoperative advanced hemodynamic monitoring is strongly advised. A key-element to obtain a fast recovery is the multimodal pain management. With the implementation of minimally invasive surgery in colorectal surgery the abdominal wall blocks should be preferred to thoracic epidural analgesia which can play a negative role on patient’s mobilization and recovery 20,21 . Laparoscopy is a cornerstone of the enhanced recovery philosophy as the minimally invasive surgical approach allows to minimize the surgical stress and promotes a fast recovery 22–25 . Not surprisingly, preoperative CHO load was associated with a fast recovery, in fact previous studies reported that CHO load was associated to reduced insulin resistance, better postoperative glycemic control, and shortened length of hospital stay 22,26 . Preoperative counseling and removal of NGT at the end of surgery were widely applied in our series. A specific booklet enhanced patients information and involvement in the perioperative pathway, promoting an active awareness. The removal of NGT at the end of surgery yields early oral feeding and mobilization, and a subjective well being. A previous study identified active warming as one of the core items of the enhanced perioperative pathway 10 . In the present series active warming was performed in 98% of patients making not reliable any statistical evaluation on its role. Long duration of surgery and diverting stoma negatively affected postoperative recovery. They could be Indicators of surgery difficulty and invasiveness or patient’s frailty. The application of enhanced recovery protocols outside of clinical trials is highly variable. A multicenter study carried out on 2352 patients undergoing elective colorectal surgery in 13 European hospitals showed a 75% adherence to ERP items 22 . The multidisciplinary protocol and the high number of items make the full application of the program quite difficult also explaining the great variability reported in literature 23 . To identify some ERP items with a greater impact on patient’s recovery could promote a further spread of enhanced recovery protocols. The study has some limitations. This is a retrospective analysis of a prospectively collected and dedicated register, including data from many different centers. However all included centers shared the same protocol and training. Moreover the large case mix reflected by the high median age and the substantial proportion of patients with high ASA score could be considered an indicator of small likelihood of selection bias. CONCLUSION The present study showed that a late recovery occurred in about one third of the overall series. However, in the subgroup of patients receiving pre-admission counseling, preoperative CHO drink, operative fluid infusions < 7mL/kg/h, successful laparoscopy, removal of NGT at the end of surgery, and avoiding thoracic epidural analgesia the late recovery rate dropped to 13%. The implementation of these items by the multiprofessional staff seems crucial to enhance the short-term recovery following colorectal surgery. Declarations Funding : no grant support nor funding received in the course of study, research or assembly of the manuscript. Conflicts of interest/Competing interests : All authors have no conflict of interest nor competing interests to declare Consent to Participate: Informed consent was obtained from all individual participants included in the study. Human Ethics and Consent to Participate declarations : this retrospective study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. No ethical approval was necessary owing to the retrospective, observational, and anonymous nature of this study. Data Availability declaration: raw data for dataset are not publicly available to preserve individuals’ privacy under the European General Data Protection Regulation. References Fearon KCH, Ljungqvist O, Von Meyenfeldt M, et al. Enhanced recovery after surgery: A consensus review of clinical care for patients undergoing colonic resection. 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World J Surg . 2019;43(3):659-695. doi:10.1007/s00268-018-4844-y Currie A, Burch J, Jenkins JT, et al. The Impact of Enhanced Recovery Protocol Compliance on Elective Colorectal Cancer Resection. Ann Surg . 2015;261(6):1153-1159. doi:10.1097/SLA.0000000000001029 Dindo D, Demartines N, Clavien PA. Classification of Surgical Complications. Ann Surg . 2004;240(2):205-213. doi:10.1097/01.sla.0000133083.54934.ae Ceresoli M, Braga M. Reply to: Early non compliance to enhanced recovery pathway might be an alert for underlying complications following colon surgery. European Journal of Surgical Oncology . 2023;49(2):526. doi:10.1016/j.ejso.2022.10.010 Asklid D, Segelman J, Gedda C, Hjern F, Pekkari K, Gustafsson UO. The impact of perioperative fluid therapy on short-term outcomes and 5-year survival among patients undergoing colorectal cancer surgery – A prospective cohort study within an ERAS protocol. 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Langenbecks Arch Surg . 2021;406(2):273-282. doi:10.1007/s00423-020-01995-9 Currie A, Burch J, Jenkins JT, et al. The impact of enhanced recovery protocol compliance on elective colorectal cancer resection: Results from an international registry. Ann Surg . 2015;261(6):1153-1159. doi:10.1097/SLA.0000000000001029 Messenger DE, Curtis NJ, Jones A, Jones EL, Smart NJ, Francis NK. Factors predicting outcome from enhanced recovery programmes in laparoscopic colorectal surgery: a systematic review. Surg Endosc . 2017;31(5):2050-2071. doi:10.1007/S00464-016-5205-2 Chok AY, Zhao Y, Tan IEH, Au MKH, Tan EJKW. Cost-effectiveness comparison of minimally invasive, robotic and open approaches in colorectal surgery: a systematic review and bayesian network meta-analysis of randomized clinical trials. Int J Colorectal Dis . 2023;38(1):86. doi:10.1007/S00384-023-04361-5 Braga M, Borghi F, Scatizzi M, et al. Impact of laparoscopy on adherence to an enhanced recovery pathway and readiness for discharge in elective colorectal surgery: Results from the PeriOperative Italian Society registry. Surg Endosc . 2017;31(11):4393-4399. doi:10.1007/s00464-017-5486-0 Awad S, Varadhan KK, Ljungqvist O, Lobo DN. A meta-analysis of randomised controlled trials on preoperative oral carbohydrate treatment in elective surgery. Clinical Nutrition . 2013;32(1):34-44. doi:10.1016/j.clnu.2012.10.011 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 24 Sep, 2024 Read the published version in Techniques in Coloproctology → Version 1 posted Editorial decision: Revision requested 03 Apr, 2024 Reviews received at journal 16 Mar, 2024 Reviewers agreed at journal 09 Mar, 2024 Reviewers invited by journal 06 Mar, 2024 Editor assigned by journal 06 Mar, 2024 Submission checks completed at journal 28 Feb, 2024 First submitted to journal 21 Feb, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3975177","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":275375541,"identity":"7198eb9a-3f0e-4a3b-813f-77110f9ca667","order_by":0,"name":"Marco Ceresoli","email":"","orcid":"","institution":"University Milano-Bicocca","correspondingAuthor":false,"prefix":"","firstName":"Marco","middleName":"","lastName":"Ceresoli","suffix":""},{"id":275375542,"identity":"78e61def-34ac-4661-9dfb-d2c35919c9da","order_by":1,"name":"Lorenzo Ripamonti","email":"data:image/png;base64,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","orcid":"","institution":"Fondazione IRCCS San Gerardo dei Tintori","correspondingAuthor":true,"prefix":"","firstName":"Lorenzo","middleName":"","lastName":"Ripamonti","suffix":""},{"id":275375543,"identity":"2a694d45-0c3d-49a9-bce9-0abeaa7f599d","order_by":2,"name":"Corrado Pedrazzani","email":"","orcid":"","institution":"University of Verona","correspondingAuthor":false,"prefix":"","firstName":"Corrado","middleName":"","lastName":"Pedrazzani","suffix":""},{"id":275375544,"identity":"5a5fe66f-da62-4a16-a5ba-70410169c1be","order_by":3,"name":"Luca Pellegrino","email":"","orcid":"","institution":"Cuneo Hospital","correspondingAuthor":false,"prefix":"","firstName":"Luca","middleName":"","lastName":"Pellegrino","suffix":""},{"id":275375545,"identity":"9b8de334-31f3-447a-bd8c-36ad19cad22a","order_by":4,"name":"Nicolò Tamini","email":"","orcid":"","institution":"Fondazione IRCCS San Gerardo dei Tintori","correspondingAuthor":false,"prefix":"","firstName":"Nicolò","middleName":"","lastName":"Tamini","suffix":""},{"id":275375546,"identity":"cbb2a3f1-2ed7-407f-92db-dc3312a7f1aa","order_by":5,"name":"Mauro Totis","email":"","orcid":"","institution":"Fondazione IRCCS San Gerardo dei Tintori","correspondingAuthor":false,"prefix":"","firstName":"Mauro","middleName":"","lastName":"Totis","suffix":""},{"id":275375547,"identity":"9605440a-141b-4a2b-8bd4-c3cb7de6cab2","order_by":6,"name":"Marco Braga","email":"","orcid":"","institution":"University Milano-Bicocca","correspondingAuthor":false,"prefix":"","firstName":"Marco","middleName":"","lastName":"Braga","suffix":""}],"badges":[],"createdAt":"2024-02-21 10:09:59","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3975177/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3975177/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s10151-024-03004-3","type":"published","date":"2024-09-24T15:56:56+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":51971070,"identity":"6a7cef8f-b21e-45bb-9b4a-b727c5b0228f","added_by":"auto","created_at":"2024-03-04 18:49:57","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":516305,"visible":true,"origin":"","legend":"\u003cp\u003eOverall adherence to preoperative and intraoperative protocol items\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-3975177/v1/19453e98bcfcd68870572fc8.png"},{"id":51971071,"identity":"d794bf2e-8a66-46cd-9774-7fd0e0069294","added_by":"auto","created_at":"2024-03-04 18:49:57","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":161934,"visible":true,"origin":"","legend":"\u003cp\u003eLate recovery according to the number of positive items achieved\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-3975177/v1/6ba10cd7b3700d86197d923c.png"},{"id":65627055,"identity":"8fdce285-ea53-4b86-a604-f71184e725d7","added_by":"auto","created_at":"2024-09-30 16:10:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1703754,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3975177/v1/33ad8c76-928f-4231-bbcd-2cbad7c5259c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Determinants of late recovery following elective colorectal surgery. Late recovery within ERAS pathway","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eA fast recovery after colorectal surgery is the result of a multifactorial and multidisciplinary perioperative pathway focused on reducing surgical stress \u003csup\u003e1\u0026ndash;3\u003c/sup\u003e. The implementation of enhanced recovery protocols (ERP) improved short-term outcome and reduced health care costs also in elderly and frail patients \u003csup\u003e4\u0026ndash;7\u003c/sup\u003e. However, recent studies reported that a proportion of 25\u0026ndash;30% of patients who underwent colorectal resection showed a late postoperative recovery \u003csup\u003e6\u0026ndash;8\u003c/sup\u003e. A close relationship between a late recovery and overall morbidity has been reported \u003csup\u003e9\u0026ndash;11\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eA late recovery after colorectal surgery could be associated to several factors such as: patient's age and comorbidities, suboptimal adherence to perioperative ERP, exuberant postoperative inflammatory response, and incoming complications. The identification of possible determinants of late recovery might be crucial to implement perioperative protocols and to plan tailored pathways, particularly in high-risk patients.\u003c/p\u003e \u003cp\u003eThe aim of this study is to identify possible determinants of late recovery in a large series of patients undergoing colorectal surgery.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003eThe present study is reported according to the STROBE guidelines for the conducting and reporting of observational cohort studies \u003csup\u003e12\u003c/sup\u003e. We reviewed a prospectively collected database including patients undergoing elective colorectal surgery, in 22 Italian hospitals affiliated with the PeriOperative Italian Society. All hospitals treated patients within an extensive ERP according to international guidelines \u003csup\u003e13\u003c/sup\u003e. Collected data included demographics, patient comorbidities, preoperative and intraoperative parameters, surgical technique, adherence to preoperative/intraoperative ERP items, postoperative recovery indicators, and short-term outcome variables. All patients were given intravenous short-term antibiotic and deep venous thrombosis prophylaxes according to ERP recommendations \u003csup\u003e13\u003c/sup\u003e. High adherence to preoperative / intraoperative protocol was defined when more than 80% of items were applied \u003csup\u003e14\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe same day of surgery patients were mobilized out of bed and were allowed to take liquids by mouth at will. Removal of urinary catheter and starting of oral feeding were planned on postoperative day (POD) 1. Intravenous fluid infusion was stopped as early as possible according to oral feeding recovery. Indicators of postoperative recovery were oral feeding, urinary catheter removal, intravenous fluids stop, and mobilization assessed on POD 2. Late recovery was defined as the failure to meet at least two indicators on POD 2 \u003csup\u003e6,8\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eCriteria to identify postoperative complications were a priori defined and complications were graded according to Clavien-Dindo classification \u003csup\u003e15\u003c/sup\u003e. Complications graded as III to V were considered as major. Discharge criteria were no clinical or laboratory evidence of postoperative complications, good pain control with oral analgesics, adequate oral food intake with no need for intravenous fluids, recovered mobilization, and recovery of bowel function defined as passage of flatus. Post-operative follow-up was carried out for 30 days after hospital discharge. Hospital readmission for any postoperative complication occurring within 30 days after discharge was also recorded.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistics\u003c/h2\u003e \u003cp\u003eContinuous variables were reported as median (Interquartile range) while categorical variables were reported as number (percentage). Univariate analysis was carried out to identify predictive variables for postoperative compliance. Significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) variables associated with postoperative compliance at the univariate analysis were used to run a logistic multivariate regression model. Statistics were performed with SPSS 25 (IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp)\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 1850 patients undergoing elective colorectal resection were collected. After the exclusion of 314 patients with missing data a total of 1536 patients were included in the analysis. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the characteristics of the patients. Median age was 70 (61\u0026ndash;78),1322 (86.1%) patients underwent surgery for cancer, 503 (32.8%) patients were ASA 3 or 4, and 1177 (76.7%) patients underwent laparoscopic surgery.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatients characteristics.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMedian(IQR)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e70 (61\u0026ndash;78)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e832\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e703\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25 (22\u0026ndash;27)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight loss\u0026thinsp;\u0026gt;\u0026thinsp;5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMUST\u003csup\u003e\u0026sect;\u003c/sup\u003e score\u0026thinsp;\u0026gt;\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e208\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eASA score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e177\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e854\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e449\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e192\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePreoperative Hb (mg/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13 (\u003cspan additionalcitationids=\"CR12 CR13\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHb\u0026thinsp;\u0026gt;\u0026thinsp;12 g/dL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e983\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1322\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e86.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeoadjuvant CT/RT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgery duration\u0026thinsp;\u0026gt;\u0026thinsp;180 min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e876\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRectal surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e387\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperative vasoactive drugs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiverting stoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e265\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003e\u0026sect; Malnutrition Universal Screening Tool\u003c/sup\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the adherence to each preoperative and intraoperative ERP item. The overall median adherence was 75.0% (66.6%- 83.3%). The highest adherence was found for active warming and preoperative counselling, while the lowest for avoiding abdominal drain.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eA late recovery was observed in 488 (31.8%) patients of the overall series, in 295 (30.6%) subjects when considering the subgroup of uneventful patients, and in 180 (26.7%) patients of the subgroup with high adherence to preoperative / intraoperative protocol.\u003c/p\u003e \u003cp\u003eShort-term postoperative outcome is reported in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Overall 30-day morbidity was 24.7% (379 patients) and major complications occurred in 55 (3.6%) patients. Median length of stay was 6 (\u003cspan additionalcitationids=\"CR6 CR7\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) days, Readmission was recorded in 34 (2.2%) patients.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eShort-term postoperative outcomes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMedian(IQR)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall 30-day Morbidity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e379\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMajor complication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClavien-Dindo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e215\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIIIa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIIIb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIVa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIVb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnastomotic leak\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRespiratory complication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSSI\u003csup\u003e\u0026sect;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrinary tract infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReoperation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of hospital stay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (\u003cspan additionalcitationids=\"CR6 CR7 CR8\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReadmission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003e\u0026sect; Surgical Site Infection\u003c/sup\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eMultiple regression analysis showed that long duration of surgery (OR 0.548), diverting stoma (0.289), and postoperative morbidity (OR 0.458) were associated to late recovery (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Six ERP items had an independent positive impact on postoperative recovery (positive items): pre-admission counseling (OR 2.596), preoperative carbohydrate (CHO) drink (OR 1.948), intraoperative fluid infusions\u0026thinsp;\u0026lt;\u0026thinsp;7mL/kg/h (OR 1.662), avoiding thoracic epidural analgesia (OR 2.137), removal of naso-gastric tube (NGT) at the end of surgery (OR 4.939), and successful laparoscopy (OR 2.341).\u003c/p\u003e \u003cp style='margin:0in;line-height:115%;font-size:15px;font-family:\"Arial\",sans-serif;border:none;'\u003e\u003cspan style=\"background:white;\"\u003eTable 3. \u0026nbsp;Univariate and multiple regression analysis.\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"border: none;width:100.0%;border-collapse:collapse;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.2015%; border-top: none; border-right: none; border-left: none; border-image: initial; border-bottom: 1pt solid windowtext; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 35.6642%; border-top: none; border-right: none; border-left: none; border-image: initial; border-bottom: 1pt solid windowtext; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003eUnivariate\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 34.4833%; border-top: none; border-right: none; border-left: none; border-image: initial; border-bottom: 1pt solid windowtext; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003eMultivariate\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 22.2015%; padding: 0in 3.5pt; height: 13.8pt; vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003eOR\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 21.0206%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e95% C.I.\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 7.9123%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003eSign.\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003eOR\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 21.0206%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e95% C.I.\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003eSign.\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 9.8017%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003eLower\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003eUpper\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;\"\u003eLower\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003eUpper\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.2015%; padding: 0in 3.5pt; height: 13.8pt; vertical-align: bottom;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 7.9123%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.2015%; padding: 0in 3.5pt; height: 13.8pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;\"\u003eAge\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.981\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.971\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.990\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.9123%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.991\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.978\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e1.003\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.135\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.2015%; padding: 0in 3.5pt; height: 13.8pt; vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;\"\u003eMen\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e1.089\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.877\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e1.352\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.9123%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.439\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; 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padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.967\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e1.018\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.9123%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.560\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.2015%; padding: 0in 3.5pt; height: 13.8pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;\"\u003eWeight loss \u0026gt; 5%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.413\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.167\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; 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padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.649\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.518\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.813\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.9123%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.858\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.633\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e1.163\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.323\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.2015%; padding: 0in 3.5pt; height: 13.8pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;\"\u003eDiabetes\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.692\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.506\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.946\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.9123%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.021\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e1.070\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.709\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e1.615\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.747\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.2015%; padding: 0in 3.5pt; height: 13.8pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;\"\u003eHb \u0026gt; 12 mg/dL\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e1.283\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e1.017\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e1.620\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.9123%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.036\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e1.384\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.910\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e1.870\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.054\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.2015%; padding: 0in 3.5pt; height: 13.8pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;\"\u003eCancer\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.904\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.660\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e1.238\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.9123%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.528\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.2015%; padding: 0in 3.5pt; height: 13.8pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;\"\u003eNeoadjuvant CT/RT\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.666\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.257\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e1.169\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.9123%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.094\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e1.745\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e1.011\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e3.013\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.056\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.2015%; background: rgb(244, 176, 132); padding: 0in 3.5pt; height: 13.8pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eSurgery duration \u0026gt; 180 min\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; background: rgb(244, 176, 132); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.561\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; background: rgb(244, 176, 132); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.448\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; background: rgb(244, 176, 132); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.702\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.9123%; background: rgb(244, 176, 132); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e\u0026lt;0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; background: rgb(244, 176, 132); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.548\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; background: rgb(244, 176, 132); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.402\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; background: rgb(244, 176, 132); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.746\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; background: rgb(244, 176, 132); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.2015%; padding: 0in 3.5pt; height: 13.8pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;\"\u003eRectal surgery\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.558\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.440\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.709\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.9123%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026lt;0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.947\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.630\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e1.424\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.793\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.2015%; padding: 0in 3.5pt; height: 13.8pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;\"\u003eVasoactive drugs\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.671\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.416\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e1.081\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.9123%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.101\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.2015%; background: rgb(244, 176, 132); padding: 0in 3.5pt; height: 13.8pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eDiverting stoma\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; background: rgb(244, 176, 132); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.293\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; background: rgb(244, 176, 132); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.224\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; background: rgb(244, 176, 132); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.385\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.9123%; background: rgb(244, 176, 132); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; background: rgb(244, 176, 132); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.289\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; background: rgb(244, 176, 132); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.182\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; background: rgb(244, 176, 132); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.459\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; background: rgb(244, 176, 132); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.2015%; background: rgb(244, 176, 132); padding: 0in 3.5pt; height: 13.8pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e30-day morbidity\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; background: rgb(244, 176, 132); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.334\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; background: rgb(244, 176, 132); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.262\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; background: rgb(244, 176, 132); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.425\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.9123%; background: rgb(244, 176, 132); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; background: rgb(244, 176, 132); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.458\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; background: rgb(244, 176, 132); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.341\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; background: rgb(244, 176, 132); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.615\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; background: rgb(244, 176, 132); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.2015%; padding: 0in 3.5pt; height: 13.8pt; vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 7.9123%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.2015%; padding: 0in 3.5pt; height: 13.8pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;\"\u003eEnhanced Recovery Protocol \u0026nbsp;Items\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 7.9123%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.2015%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eCounselling\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e3.019\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e1.961\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e4.650\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.9123%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e2.596\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e1.505\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e4.478\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.2015%; padding: 0in 3.5pt; height: 13.8pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;\"\u003eNo mechanical oral bowel preparation\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.968\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.713\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e1.314\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.9123%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.835\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.2015%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003ePreop. CHO load\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e1.610\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e1.292\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e2.005\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.9123%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e1.948\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e1.461\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e2.597\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.2015%; padding: 0in 3.5pt; height: 13.8pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;\"\u003eNo premedication\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.842\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.677\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e1.047\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.9123%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.121\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.2015%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eInfusions \u0026lt; 7ml/Kg/h\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e1.328\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e1.\u003c/span\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e061\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e1.661\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.9123%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.013\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e1.662\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e1.256\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e2.200\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.2015%; padding: 0in 3.5pt; height: 13.8pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;\"\u003eBalanced anesthesia\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.977\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.388\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e1.526\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.9123%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.077\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.2015%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eNo thoracic epidural analgesia\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e1.586\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e1.264\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e1.991\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.9123%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e\u0026lt;0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e2.137\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e1.583\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e2.884\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.2015%; padding: 0in 3.5pt; height: 13.8pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;\"\u003eActive warming\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.743\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.330\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e1.673\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.9123%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.473\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.2015%; padding: 0in 3.5pt; height: 13.8pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;\"\u003ePONV* prophylaxis\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.988\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.482\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e1.453\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.9123%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.106\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.2015%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eSuccessful laparoscopy\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e3.214\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e2.515\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e4.107\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.9123%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e2.341\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e1.738\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e3.153\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.2015%; padding: 0in 3.5pt; height: 13.8pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;\"\u003eNo Drain\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.637\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.500\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.812\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.9123%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e1.094\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.806\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e1.483\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;\"\u003e0.564\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.2015%; border-top: none; border-right: none; border-left: none; border-image: initial; border-bottom: 1pt solid windowtext; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eNaso-gastric tube removal (end of surgery)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; border-top: none; border-right: none; border-left: none; border-image: initial; border-bottom: 1pt solid windowtext; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e6.426\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; border-top: none; border-right: none; border-left: none; border-image: initial; border-bottom: 1pt solid windowtext; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e4.332\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; border-top: none; border-right: none; border-left: none; border-image: initial; border-bottom: 1pt solid windowtext; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e9.527\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.9123%; border-top: none; border-right: none; border-left: none; border-image: initial; border-bottom: 1pt solid windowtext; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e\u0026lt;0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; border-top: none; border-right: none; border-left: none; border-image: initial; border-bottom: 1pt solid windowtext; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e4.939\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.8017%; border-top: none; border-right: none; border-left: none; border-image: initial; border-bottom: 1pt solid windowtext; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e3.003\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2189%; border-top: none; border-right: none; border-left: none; border-image: initial; border-bottom: 1pt solid windowtext; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e8.124\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.7313%; background: rgb(169, 208, 142); padding: 0in 3.5pt; height: 13.8pt;\"\u003e\n \u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;text-align:center;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;'\u003e\u003csup\u003e\u0026sect;\u0026nbsp;\u003c/sup\u003e\u003csup\u003e\u003cspan style=\"color:black;\"\u003e\u003cspan style=\"color:black;text-decoration:none;\"\u003eMalnutrition Universal Screening Tool\u003c/span\u003e\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003cp style='margin:0in;line-height:normal;font-size:15px;font-family:\"Arial\",sans-serif;'\u003e\u003csup\u003e\u003cspan style=\"color:black;\"\u003e*\u003c/span\u003e\u003c/sup\u003e\u003cspan style=\"color:black;background:white;\"\u003e\u003csup\u003epost\u003cspan style=\"color:black;background:white;\"\u003eoperative nausea and vomiting\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows that the late recovery rate progressively declined with the increasing adherence to the six positive items reaching 13.0% when all the items were applied (r= -0.99 p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe present study demonstrated that a late recovery following colorectal surgery occurred in about one third of patients. Long duration of surgery, diverting stoma and postoperative morbidity were significantly associated to late recovery, whereas pre-admission counseling, preoperative CHO drink, avoiding thoracic epidural analgesia, intraoperative fluid infusions\u0026thinsp;\u0026lt;\u0026thinsp;7mL/Kg/h, removal of NGT at the end of surgery, and successful laparoscopy were associated with fast recovery. In the subgroup of patients who met all the six positive items the late recovery rate was 13%.\u003c/p\u003e \u003cp\u003ePrevious studies showed that advanced age and comorbidities, fluid overload, diverting stoma, suboptimal pain control, and exuberant inflammatory response were possible determinants of early postoperative low compliance to enhanced recovery protocols\u003csup\u003e6,8\u003c/sup\u003e. Moreover, early low compliance could be an indicator of incoming complications and was associated to higher overall morbidity following colorectal surgery \u003csup\u003e6\u003c/sup\u003e. The relationship between the adherence to preoperative/intraoperative protocol and compliance to postoperative pathway is a very important issue. Adherence which identifies the ERP items application is related to the protocol implementation by the multiprofessional team. Patient\u0026rsquo;s compliance to postoperative pathway should be considered as the result of ERP implementation and directly impacts on recovery. Therefore, the fast recovery after surgery may reflect the effectiveness of preoperative / intraoperative pathway \u003csup\u003e16\u003c/sup\u003e. In the present study the impact of preoperative / intraoperative items adherence on postoperative recovery has been evaluated.\u003c/p\u003e \u003cp\u003eIn our series, the proportion of patients with a late recovery was about 30%. In the subgroup of patients with high adherence to preoperative / intraoperative protocol the late recovery rate remained comparable. For this reason we explored the impact of each ERP item on postoperative recovery.\u003c/p\u003e \u003cp\u003eThe multiple regression analysis allowed to identify six ERP items with a positive impact on postoperative recovery. Some items had a suboptimal adherence and therefore should be implemented. Among these the goal directed fluid therapy is one of the most important determinants of GI function recovery \u003csup\u003e9,10,17\u0026ndash;19\u003c/sup\u003e. To avoid the risk of fluid overload an intraoperative advanced hemodynamic monitoring is strongly advised. A key-element to obtain a fast recovery is the multimodal pain management. With the implementation of minimally invasive surgery in colorectal surgery the abdominal wall blocks should be preferred to thoracic epidural analgesia which can play a negative role on patient\u0026rsquo;s mobilization and recovery \u003csup\u003e20,21\u003c/sup\u003e. Laparoscopy is a cornerstone of the enhanced recovery philosophy as the minimally invasive surgical approach allows to minimize the surgical stress and promotes a fast recovery \u003csup\u003e22\u0026ndash;25\u003c/sup\u003e. Not surprisingly, preoperative CHO load was associated with a fast recovery, in fact previous studies reported that CHO load was associated to reduced insulin resistance, better postoperative glycemic control, and shortened length of hospital stay \u003csup\u003e22,26\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003ePreoperative counseling and removal of NGT at the end of surgery were widely applied in our series. A specific booklet enhanced patients information and involvement in the perioperative pathway, promoting an active awareness. The removal of NGT at the end of surgery yields early oral feeding and mobilization, and a subjective well being. A previous study identified active warming as one of the core items of the enhanced perioperative pathway \u003csup\u003e10\u003c/sup\u003e. In the present series active warming was performed in 98% of patients making not reliable any statistical evaluation on its role. Long duration of surgery and diverting stoma negatively affected postoperative recovery. They could be Indicators of surgery difficulty and invasiveness or patient\u0026rsquo;s frailty.\u003c/p\u003e \u003cp\u003eThe application of enhanced recovery protocols outside of clinical trials is highly variable. A multicenter study carried out on 2352 patients undergoing elective colorectal surgery in 13 European hospitals showed a 75% adherence to ERP items \u003csup\u003e22\u003c/sup\u003e. The multidisciplinary protocol and the high number of items make the full application of the program quite difficult also explaining the great variability reported in literature \u003csup\u003e23\u003c/sup\u003e. To identify some ERP items with a greater impact on patient\u0026rsquo;s recovery could promote a further spread of enhanced recovery protocols.\u003c/p\u003e \u003cp\u003eThe study has some limitations. This is a retrospective analysis of a prospectively collected and dedicated register, including data from many different centers. However all included centers shared the same protocol and training. Moreover the large case mix reflected by the high median age and the substantial proportion of patients with high ASA score could be considered an indicator of small likelihood of selection bias.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe present study showed that a late recovery occurred in about one third of the overall series. However, in the subgroup of patients receiving pre-admission counseling, preoperative CHO drink, operative fluid infusions\u0026thinsp;\u0026lt;\u0026thinsp;7mL/kg/h, successful laparoscopy, removal of NGT at the end of surgery, and avoiding thoracic epidural analgesia the late recovery rate dropped to 13%. The implementation of these items by the multiprofessional staff seems crucial to enhance the short-term recovery following colorectal surgery.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: no grant support nor funding\u0026nbsp;received in the course of study, research or assembly of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest/Competing interests\u003c/strong\u003e:\u0026nbsp;All authors have no conflict of interest nor competing interests to declare\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate:\u003c/strong\u003e Informed consent was obtained from all individual participants included in the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate declarations\u003c/strong\u003e:\u0026nbsp;this retrospective study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. \u0026nbsp;No ethical approval was necessary owing to the retrospective, observational, and anonymous nature of this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability declaration:\u003c/strong\u003e raw data for dataset are not publicly available to preserve individuals’ privacy under the European General Data Protection Regulation.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eFearon KCH, Ljungqvist O, Von Meyenfeldt M, et al. Enhanced recovery after surgery: A consensus review of clinical care for patients undergoing colonic resection. \u003cem\u003eClinical Nutrition\u003c/em\u003e. 2005;24(3):466-477. doi:10.1016/j.clnu.2005.02.002\u003c/li\u003e\n\u003cli\u003eLjungqvist O, Scott M, Fearon KC. Enhanced Recovery After Surgery: A Review. \u003cem\u003eJAMA Surg\u003c/em\u003e. 2017;152(3):292-298. doi:10.1001/JAMASURG.2016.4952\u003c/li\u003e\n\u003cli\u003eGreco M, Capretti G, Beretta L, Gemma M, Pecorelli N, Braga M. Enhanced Recovery Program in Colorectal Surgery: A Meta-analysis of Randomized Controlled Trials. \u003cem\u003eWorld J Surg\u003c/em\u003e. 2014;38(6):1531-1541. doi:10.1007/s00268-013-2416-8\u003c/li\u003e\n\u003cli\u003eLiu XR, Liu XY, Zhang B, et al. Enhanced recovery after colorectal surgery is a safe and effective pathway for older patients: a pooling up analysis. \u003cem\u003eInt J Colorectal Dis\u003c/em\u003e. 2023;38(1). doi:10.1007/S00384-023-04377-X\u003c/li\u003e\n\u003cli\u003eMart\u0026iacute;nez-Escribano C, Arteaga Moreno F, Cuesta Peredo D, Blanco Gonzalez FJ, De la C\u0026aacute;mara-de las Heras JM, Tarazona Santabalbina FJ. Before-and-After Study of the First Four Years of the Enhanced Recovery after Surgery (ERAS\u0026reg;) Programme in Older Adults Undergoing Elective Colorectal Cancer Surgery. \u003cem\u003eInt J Environ Res Public Health\u003c/em\u003e. 2022;19(22). doi:10.3390/IJERPH192215299\u003c/li\u003e\n\u003cli\u003eCeresoli M, Pedrazzani C, Pellegrino L, et al. Early non compliance to enhanced recovery pathway might be an alert for underlying complications following colon surgery. \u003cem\u003eEuropean Journal of Surgical Oncology\u003c/em\u003e. Published online July 2022. doi:10.1016/j.ejso.2022.06.033\u003c/li\u003e\n\u003cli\u003eBraga M, Pecorelli N, Scatizzi M, Borghi F, Missana G, Radrizzani D. Enhanced Recovery Program in High-Risk Patients Undergoing Colorectal Surgery: Results from the PeriOperative Italian Society Registry. \u003cem\u003eWorld J Surg\u003c/em\u003e. 2017;41(3):860-867. doi:10.1007/s00268-016-3766-9\u003c/li\u003e\n\u003cli\u003eCeresoli M, Pedrazzani C, Pellegrino L, et al. Early Postoperative Low Compliance to Enhanced Recovery Pathway in Rectal Cancer Patients. \u003cem\u003eCancers (Basel)\u003c/em\u003e. 2022;14(23). doi:10.3390/CANCERS14235736\u003c/li\u003e\n\u003cli\u003eGemma M, Pennoni F, Braga M. Studying Enhanced Recovery After Surgery (ERAS\u0026reg;) Core Items in Colorectal Surgery: A Causal Model with Latent Variables. \u003cem\u003eWorld J Surg\u003c/em\u003e. 2021;45(4):928-939. doi:10.1007/S00268-020-05940-1\u003c/li\u003e\n\u003cli\u003eBraga M, Scatizzi M, Borghi F, et al. Identification of core items in the enhanced recovery pathway. \u003cem\u003eClin Nutr ESPEN\u003c/em\u003e. 2018;25:139-144. doi:10.1016/J.CLNESP.2018.03.003\u003c/li\u003e\n\u003cli\u003eMeillat H, Brun C, Zemmour C, et al. Laparoscopy is not enough: full ERAS compliance is the key to improvement of short-term outcomes after colectomy for cancer. \u003cem\u003eSurg Endosc\u003c/em\u003e. 2020;34(5):2067-2075. doi:10.1007/s00464-019-06987-5\u003c/li\u003e\n\u003cli\u003eElm E von, Altman DG, Egger M, Pocock SJ, G\u0026oslash;tzsche PC, Vandenbroucke JP. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. \u003cem\u003eBMJ\u003c/em\u003e. 2007;335(7624):806-808. doi:10.1136/BMJ.39335.541782.AD\u003c/li\u003e\n\u003cli\u003eGustafsson UO, Scott MJ, Hubner M, et al. Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS\u0026reg;) Society Recommendations: 2018. \u003cem\u003eWorld J Surg\u003c/em\u003e. 2019;43(3):659-695. doi:10.1007/s00268-018-4844-y\u003c/li\u003e\n\u003cli\u003eCurrie A, Burch J, Jenkins JT, et al. The Impact of Enhanced Recovery Protocol Compliance on Elective Colorectal Cancer Resection. \u003cem\u003eAnn Surg\u003c/em\u003e. 2015;261(6):1153-1159. doi:10.1097/SLA.0000000000001029\u003c/li\u003e\n\u003cli\u003eDindo D, Demartines N, Clavien PA. Classification of Surgical Complications. \u003cem\u003eAnn Surg\u003c/em\u003e. 2004;240(2):205-213. doi:10.1097/01.sla.0000133083.54934.ae\u003c/li\u003e\n\u003cli\u003eCeresoli M, Braga M. Reply to: Early non compliance to enhanced recovery pathway might be an alert for underlying complications following colon surgery. \u003cem\u003eEuropean Journal of Surgical Oncology\u003c/em\u003e. 2023;49(2):526. doi:10.1016/j.ejso.2022.10.010\u003c/li\u003e\n\u003cli\u003eAsklid D, Segelman J, Gedda C, Hjern F, Pekkari K, Gustafsson UO. The impact of perioperative fluid therapy on short-term outcomes and 5-year survival among patients undergoing colorectal cancer surgery \u0026ndash; A prospective cohort study within an ERAS protocol. \u003cem\u003eEuropean Journal of Surgical Oncology\u003c/em\u003e. 2017;43(8):1433-1439. doi:10.1016/j.ejso.2017.04.003\u003c/li\u003e\n\u003cli\u003eBellamy MC. Wet, dry or something else? \u003cem\u003eBr J Anaesth\u003c/em\u003e. 2006;97(6):755-757. doi:10.1093/BJA/AEL290\u003c/li\u003e\n\u003cli\u003eThacker JKM, Mountford WK, Ernst FR, Krukas MR, Mythen MG. Perioperative fluid utilization variability and association with outcomes : Considerations for enhanced recovery efforts in sample US surgical populations. \u003cem\u003eAnn Surg\u003c/em\u003e. 2016;263(3):502-510. doi:10.1097/SLA.0000000000001402\u003c/li\u003e\n\u003cli\u003eH\u0026uuml;bner M, Blanc C, Roulin D, Winiker M, Gander S, Demartines N. Randomized clinical trial on epidural versus patient-controlled analgesia for laparoscopic colorectal surgery within an enhanced recovery pathway. \u003cem\u003eAnn Surg\u003c/em\u003e. 2015;261(4):648-653. doi:10.1097/SLA.0000000000000838\u003c/li\u003e\n\u003cli\u003eHamid HKS, Marc-Hern\u0026aacute;ndez A, Saber AA. Transversus abdominis plane block versus thoracic epidural analgesia in colorectal surgery: a systematic review and meta-analysis. \u003cem\u003eLangenbecks Arch Surg\u003c/em\u003e. 2021;406(2):273-282. doi:10.1007/s00423-020-01995-9\u003c/li\u003e\n\u003cli\u003eCurrie A, Burch J, Jenkins JT, et al. The impact of enhanced recovery protocol compliance on elective colorectal cancer resection: Results from an international registry. \u003cem\u003eAnn Surg\u003c/em\u003e. 2015;261(6):1153-1159. doi:10.1097/SLA.0000000000001029\u003c/li\u003e\n\u003cli\u003eMessenger DE, Curtis NJ, Jones A, Jones EL, Smart NJ, Francis NK. Factors predicting outcome from enhanced recovery programmes in laparoscopic colorectal surgery: a systematic review. \u003cem\u003eSurg Endosc\u003c/em\u003e. 2017;31(5):2050-2071. doi:10.1007/S00464-016-5205-2\u003c/li\u003e\n\u003cli\u003eChok AY, Zhao Y, Tan IEH, Au MKH, Tan EJKW. Cost-effectiveness comparison of minimally invasive, robotic and open approaches in colorectal surgery: a systematic review and bayesian network meta-analysis of randomized clinical trials. \u003cem\u003eInt J Colorectal Dis\u003c/em\u003e. 2023;38(1):86. doi:10.1007/S00384-023-04361-5\u003c/li\u003e\n\u003cli\u003eBraga M, Borghi F, Scatizzi M, et al. Impact of laparoscopy on adherence to an enhanced recovery pathway and readiness for discharge in elective colorectal surgery: Results from the PeriOperative Italian Society registry. \u003cem\u003eSurg Endosc\u003c/em\u003e. 2017;31(11):4393-4399. doi:10.1007/s00464-017-5486-0\u003c/li\u003e\n\u003cli\u003eAwad S, Varadhan KK, Ljungqvist O, Lobo DN. A meta-analysis of randomised controlled trials on preoperative oral carbohydrate treatment in elective surgery. \u003cem\u003eClinical Nutrition\u003c/em\u003e. 2013;32(1):34-44. doi:10.1016/j.clnu.2012.10.011\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"techniques-in-coloproctology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"tcol","sideBox":"Learn more about [Techniques in Coloproctology](http://link.springer.com/journal/10151)","snPcode":"10151","submissionUrl":"https://submission.nature.com/new-submission/10151/3","title":"Techniques in Coloproctology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Late recovery, enhanced recovery protocol, ERAS, colorectal surgery","lastPublishedDoi":"10.21203/rs.3.rs-3975177/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3975177/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground. \u003c/strong\u003eDespite the application of enhanced recovery protocol a considerable proportion of patients has a late recovery. The identification of possible determinants of late recovery might be crucial to implement perioperative protocols and to plan tailored pathways.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective.\u003c/strong\u003e The aim of this study is to identify possible determinants of late recovery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDesign.\u003c/strong\u003eRetrospective observational study based on a prospectively collected dedicated register.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSetting.\u003c/strong\u003e22 Italian hospital with high volume colorectal surgery and trained in enhanced recovery protocols.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatients.\u003c/strong\u003ePatients with elective colorectal resection for cancer of benign disease.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMain outcome measures\u003c/strong\u003e. Recovery on postoperative day two.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults.\u003c/strong\u003e A total of 1536 patients were included in the analysis. The overall median adherence to preoperative and intraoperative enhanced recovery protocols item was 75.0% (66.6%- 83.3%). A late recovery was observed in 488 (31.8%) patients. Multiple regression analysis showed that six enhanced recovery protocols items had an independent positive impact on postoperative recovery: pre-admission counseling (OR 2.596), preoperative carbohydrate drink (OR 1.948), intraoperative fluid infusions \u0026lt;7mL/kg/h (OR 1.662), avoiding thoracic epidural analgesia(OR 2.137), removal of naso-gastric tube at the end of surgery (OR 4.939) and successful laparoscopy (OR 2.341). The late recovery rate progressively declined with the increasing adherence to these six positive items reaching 13.0% when all the items were applied (r= -0.99 p\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations.\u003c/strong\u003e Retrospective analysis of a register including data from many different centers and the large case mix of patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: The implementation of identified items by the multiprofessional staff seems crucial to enhance the short-term recovery following colorectal surgery.\u003c/p\u003e","manuscriptTitle":"Determinants of late recovery following elective colorectal surgery. 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