The Impact of Multidisciplinary Intervention Under the Concept of ERAS on the Prognosis of Frail Elderly Patients Undergoing Gastrectomy

The Impact of Multidisciplinary Intervention Under the Concept of ERAS on the Prognosis of Frail Elderly Patients Undergoing Gastrectomy | 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 The Impact of Multidisciplinary Intervention Under the Concept of ERAS on the Prognosis of Frail Elderly Patients Undergoing Gastrectomy Chunhong Niu, Xinrui Zhang, Yijuan Feng This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8706174/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Objective: To explore the impact of a multidisciplinary intervention model guided by the Enhanced Recovery After Surgery (ERAS) concept on the prognosis of frail elderly patients undergoing gastrectomy and to provide clinical evidence for optimizing perioperative management strategies. Methods: A prospective cohort study design was adopted. A total of 186 frail elderly patients who underwent elective gastrectomy in our hospital from January 2023 to June 2025 were selected and divided into a control group (94 cases) and a conventional group (92 cases) based on the intervention method. The conventional group received the traditional perioperative management model, while the control group was subjected to a multidisciplinary collaborative ERAS intervention plan involving the surgical department, anesthesiology, nutrition, rehabilitation, geriatrics, and the nursing team. The postoperative complication rate, hospital stay, ICU stay, postoperative functional recovery, and 30-day readmission rate were compared between the two groups, and the clinical value of the multidisciplinary ERAS intervention was analyzed. Results: The total postoperative complication rate (χ² = 7.523, P = 0.006), postoperative hospital stay, and ICU stay of the control group were significantly shorter than those of the conventional group (P < 0.001). At 7 days postoperatively, the 6-minute walk test distance and the Mini-Mental State Examination scores of the control group were significantly better than those of the conventional group (all P < 0.001). The 30-day readmission rate of the control group was lower than that of the conventional group (χ² = 4.572, P = 0.032). Conclusion: Implementing a multidisciplinary intervention based on the ERAS concept for frail elderly patients undergoing gastrectomy can significantly reduce the postoperative complication rate, shorten hospital stay, promote physical and cognitive function recovery, and improve clinical prognosis, which has important clinical promotion value. Enhanced Recovery After Surgery Multidisciplinary intervention Frailty Elderly patients Gastrectomy Prognosis 1. Introduction The global aging process is accelerating. The proportion of the elderly people aged 60 and over exceeding 18% in China[1]. The number of elderly surgical patients is increasing year by year. Gastrectomy, a common surgical procedure, poses a high risk of postoperative complications for elderly patients due to degenerative physiological changes and decreased functional reserve of multiple organs[2]. Frailty, a syndrome specific to the elderly characterized by reduced physiological reserve and decreased stress tolerance, is often associated with sarcopenia, cognitive decline, and multiple comorbidities, significantly increasing the risk of adverse postoperative outcomes. The Enhanced Recovery After Surgery (ERAS) concept, proposed by Danish surgeon Kehlet in the 1990s, optimizes perioperative care by integrating evidence-based measures to reduce surgical trauma and stress response, thereby decreasing complications and shortening hospital stays[3]. While widely applied in general surgery, the direct application of traditional ERAS protocols to frail elderly patients is challenging due to their unique physiological status and multiple comorbidities. The multidisciplinary collaborative model, integrating expertise from surgery, anesthesia, nutrition, rehabilitation, and other fields to provide individualized treatment plans, is an effective approach to address perioperative management challenges in frail elderly patients[4]. Current research indicates a significant positive correlation between frailty and postoperative complication and mortality rates in elderly patients. Research by Feng Xue et al. from Fuwai Hospital found that preoperative frailty nearly doubled the risk of postoperative pulmonary complications (OR = 1.998) and significantly prolonged mechanical ventilation and ICU stay in elderly cardiac surgery patients[5]. In the field of gastrectomy, frail patients have significantly higher rates of postoperative delirium, infection, and anastomotic leakage compared to non-frail patients[6], with hospital stays prolonged by over 30%. Prehabilitation, a key component of ERAS preoperative management, has been proven to improve surgical tolerance in frail patients. A 2024 systematic review and meta-analysis of 16 studies involving 3339 patients showed that multimodal prehabilitation could reduce the risk of major complications after major abdominal surgery in frail patients by 44%, shorten hospital stay by 1 day, and significantly increase the 6-minute walk distance[7]. However, clinical standardized protocols for ERAS-based multidisciplinary intervention are still lacking in frail elderly gastrectomy patients. It limits the full potential of such interventions. This study aims to establish a prospective cohort to evaluate the impact of a constructed multidisciplinary intervention model based on the ERAS concept on postoperative complications, hospital stay, functional recovery, and other prognostic indicators in frail elderly gastrectomy patients, thereby optimizing perioperative management strategies. The findings will provide evidence-based support for the clinical management of this patient population, promote the standardized application of the ERAS concept in the frail elderly, and hold significant value for clinical translation and practical guidance. 2. Materials and Methods 2.1 Study Participants 2.1.1 Inclusion Criteria: ① Age ≥ 60 years, meeting the WHO definition of elderly; ② Scheduled for elective gastrectomy; ③ Preoperatively assessed as frail using the Fried Frailty Phenotype (meeting 3 or more of the 5 criteria: weight loss, exhaustion, low grip strength, slow walking speed, low physical activity); ④ American Society of Anesthesiologists (ASA) physical status classification II-IV[8]; ⑤ Informed consent obtained from patients and family members; ⑥ Expected survival ≥ 6 months, able to cooperate with postoperative follow-up assessments. 2.1.2 Exclusion Criteria: ① Severe cardiovascular or cerebrovascular diseases (e.g., acute myocardial infarction, acute cerebral hemorrhage); ② Severe cognitive impairment (Mini-Mental State Examination (MMSE) score < 17); ③ Pre-existing severe infection or multiple organ failure; ④ Conversion to emergency surgery or major change in surgical procedure; ⑤ Refusal to participate in the multidisciplinary intervention or poor follow-up compliance; ⑥ Advanced malignant tumors or other terminal diseases. 2.1.3 Dropout Criteria: ① Withdrawal due to changes in condition during the study; ② Missing key data affecting outcome assessment; ③ Lost to follow-up within 30 days postoperatively. 2.2 Study Methods 2.2.1 Study Design and Grouping : A prospective cohort study design was used. Frail elderly patients scheduled for elective gastrectomy in the General Surgery and Hepatobiliary Surgery departments of our hospital were consecutively enrolled from January 2022 to June 2024. Based on the establishment timeline of the hospital's ERAS multidisciplinary team and clinical intervention implementation, patients enrolled before April 2023 received conventional perioperative management (Conventional Group), while those enrolled after April 2023 received the ERAS-based multidisciplinary intervention (Control Group). Informed consent was obtained from all participants. 2.2.2 Conventional Group Intervention: This group adopts the traditional perioperative management mode, and the specific management process is shown in Table 1 . Table 1 The specific management process of the traditional perioperative management mode Clinical Stage Management Approach Preoperative Assessment Routine history taking, physical examination, and laboratory. tests; surgical risk assessment performed solely by the surgeon. Preoperative Preparation Fasting for 8 hours, clear liquids until 6 hours preoperatively. routine bowel preparation; skin preparation one day before surgery. Intraoperative Management Conventional anesthesia protocol; drainage tubes placed as needed; no standardized temperature protection. Postoperative Management Analgesia on demand (primarily opioids); fasting until passage of flatus, then gradual diet advancement; bed rest until drain removal, then initiation of ambulation; routine nursing guidance. 2.2.3 Control Group Intervention: A multidisciplinary team (MDT) consisting of surgeons, anesthesiologists, nutritionists, rehabilitation therapists, geriatricians, and ERAS specialist nurses was established. Referring to the Expert Consensus on Enhanced Recovery After Surgery for Elderly Patients [9], an ERAS intervention protocol was implemented(Table 2 ). Table 2 ERAS intervention protocol Clinical Stage Management Approach Preoperative Assessment MDT joint assessment within 24h of admission: Comprehensive Geriatric Assessment including frailty (Fried scale), nutritional risk (NRS-2002), cognitive function (MMSE), sarcopenia (psoas muscle area at L3 level), and comorbidities. Individualized intervention plan formulated by the MDT. Preoperative Preparation Regular diet until 1 day before surgery; oral carbohydrate drink (400ml) 2h preoperatively; no routine bowel preparation (except for colorectal surgery); no routine skin shaving[11]. Intraoperative Management Anesthesia : Combined general anesthesia with epidural block to reduce opioid use; continuous Bispectral Index (BIS) monitoring maintaining depth between 40–60. Temperature Protection : Pre-warming of OR (24–26°C), forced-air warming blanket, warmed intravenous fluids and irrigation fluids (37°C) to maintain core temperature ≥ 36°C[12]. Minimally Invasive & Drain Strategy : Laparoscopic approach prioritized; abdominal drains placed only when necessary, with clear removal criteria (drainage < 100ml/24h and not turbid within 24-48h postop). Fluid Management : Goal-directed fluid therapy to maintain urine output ≥ 0.5 ml/kg/h, reducing risk of fluid overload. Postoperative Management Multimodal Analgesia : Combination of "NSAID + opioid + nerve block"; patient-controlled analgesia pump for first 48h, target pain NRS score ≤ 3[13]. Early Feeding & Nutrition : Sips of water at 6h postop, liquid diet at 12h, advancing to normal diet; continued high-protein nutritional support until postoperative day 7[14]. Early Mobilization : Assisted bed turning and limb movement within 24h; standing within 48h; gradually increasing activity with goal of ≥ 30 minutes daily by postoperative day 7[15]. Additional specific interventions for the Control Group included as shown in Table 3 . Table 3 Additional specific interventions Clinical Stage Management Approach Prehabilitation Nutrition [10]: For NRS-2002 ≥ 3, high-protein supplements (1.2-1.5g/kg/day); anemia correction preoperatively (target Hb≥120g/L). Physical Training : Individualized exercise plan including 30min daily aerobic training (e.g., indoor walking), lower limb strength training (5-time sit-to-stand test), and respiratory training for 2–4 weeks. Medication Optimization : Geriatrician-led medication review, deprescribing/adjusting high-risk drugs. Psychological Support : Counseling for anxiety to improve compliance. Complication Prevention Daily geriatrician rounds for cognitive monitoring/delirium prevention; respiratory training guided by physiotherapist to prevent pulmonary infection. Discharge & Continuity of Care Post-discharge rehabilitation plan (home exercise, nutrition, medication list); telephone follow-up or outpatient review at 1 week, 2 weeks, and 1 month postoperatively. 2.2.4 Outcome Measures: The surgical assessment indicators are shown in Table 4 , which are divided into primary outcome indicators and secondary outcome indicators. Table 4 The surgical assessment indicators indicator name Indicator content Primary Outcome Measures Postoperative total complication rate The severity of complications such as pulmonary infection, postoperative delirium, incision infection, anastomotic leakage, and lower limb deep vein thrombosis was evaluated using Clavien Dindo grading system [16]; Postoperative hospital length of stay days from surgery to discharge 30-day readmission rate proportion readmitted for surgery-related complications within 30 days Secondary Outcome Measures ICU stay time The number of days of ICU stay after surgery. Postoperative functional recovery assessed preoperatively and at postoperative day 7 using the 6-Minute Walk Test (6MWT) for physical function and MMSE for cognitive function[17]. Postoperative recovery indicators Time to first flatus, time to first ambulation. hospitalization expenses The total medical expenses of the patient's hospitalization this time. 2.2.5 Data Collection and Quality Control: Two trained research nurses collected data using standardized forms. A third-party researcher performed double-checking. All scale assessments were performed by certified professionals. 2.3 Statistical Analysis : SPSS 26.0 was used. Normally distributed continuous data are presented as mean (± SD) and compared using independent samples t-test; non-normally distributed data as median (IQR) and compared using Wilcoxon rank-sum test. Categorical data are presented as n (%) and compared using χ² or Fisher's exact test. Multivariate logistic regression identified independent factors for postoperative complications. P < 0.05 was considered statistically significant. 3. Results 3.1 Comparison of Baseline Characteristics 186 patients were enrolled (Control: n = 94; Conventional: n = 92). No significant differences were found in gender, age, BMI, ASA class, surgery type, comorbidities, or preoperative frailty score between groups (all P > 0.05), indicating comparability (Table 5 ). Table 5 Comparison of Baseline Characteristics Between Groups Characteristic Control Group (n = 94) Conventional Group (n = 92) Statistic Characteristic Gender (Male/Female, n) 53/41 51/41 χ²=0.042 0.838 Age (years, mean ± SD) 72.65 ± 5.32 73.18 ± 5.67 t=-0.624 0.533| BMI (kg/m², mean ± SD) 23.14 ± 2.87 22.86 ± 3.12 t = 0.621 0.535 ASA Class (n, %) χ²=0.365 0.833 Class II 38(40.43) 36(39.13) Class III 45(47.87) 46(50.00) Class IV 11(11.70) 10(10.87) Surgery Type (n, %) χ²=1.246 0.742 Gastrointestinal 42(44.68) 39(42.39) Hepatobiliary 31(32.98) 33(35.87) Other 21(22.34) 20(21.74) Comorbidities (n, %) Hypertension 56(59.57) 54(58.70) χ²=0.017 0.896 Diabetes 32(34.04) 30(32.61) χ²=0.045 0.832 Coronary Heart Disease 24(25.53) 23(25.00) χ²=0.007 0.933 Preop Fried Score (mean ± SD) 3.87 ± 0.72 3.92 ± 0.68 t = 0.472 0.638 Preop 6MWT (m, mean ± SD) 285.36 ± 42.18 281.54 ± 45.32 t = 0.628 0.531 Preop MMSE (score, mean ± SD) 24.68 ± 2.35 24.32 ± 2.51 t = 0.987 0.325 3.2 Comparison of Primary Outcomes The total postoperative complication rate was significantly lower in the Control Group (15.96%, 15/94) vs. the Conventional Group (32.61%, 30/92) (P = 0.006). Specifically, rates of pulmonary infection, postoperative delirium, and surgical site infection were significantly lower in the Control Group (all P 0.05). Postoperative hospital stay was shorter in the Control Group (7.24 ± 2.16 days vs. 10.58 ± 3.27 days, P < 0.001). The 30-day readmission rate was lower in the Control Group (3.19% vs. 10.87%, P = 0.032) (Table 6 ). Table 6 Comparison of Primary Outcome Measures Between Groups Outcome Measure Control Group (n = 94) Conventional Group (n = 92) Statistic P-value Total Complications (n, %) 15(15.96) 30(32.61) χ²=7.523 0.006 Pulmonary Infection 4(4.26) 13(14.13) χ²=6.058 0.014 Postoperative Delirium 5(5.32) 15(16.30) χ²=6.874 0.009 Surgical Site Infection 2(2.13) 9(9.78) χ²=5.126 0.024 Anastomotic Leakage 2(2.13) 3(3.26) χ²=0.238 0.626 Deep Vein Thrombosis 2(2.13) 2(2.17) χ²=0.000 0.992 Postop Hospital Stay (days, mean ± SD) 7.24 ± 2.16 10.58 ± 3.27 t=-8.142 < 0.001 30-day Readmission Rate (n, %) 3(3.19) 10(10.87) χ²=4.572 0.032 3.3 Comparison of Secondary Outcomes ICU stay was shorter in the Control Group (1.02 ± 0.85 days vs. 2.36 ± 1.42 days, P < 0.001). At postoperative day 7, the Control Group had longer 6MWT distance (326.54 ± 48.72m vs. 291.36 ± 45.87m, P < 0.001) and higher MMSE scores (26.85 ± 2.13 vs. 24.12 ± 2.36, P < 0.001). Time to first flatus, time to first ambulation were earlier, and total hospitalization costs were lower in the Control Group (all P < 0.001) (Table 7 ). Table 7 Comparison of Secondary Outcome Measures Between Groups Outcome Measure Control Group (n = 94) Conventional Group (n = 92) Statistic P-value ICU Stay (days, mean ± SD) 1.02 ± 0.85 2.36 ± 1.42 t=-8.265 < 0.001 6MWT at Postop Day 7 (m, mean ± SD) 326.54 ± 48.72 291.36 ± 45.87 t = 4.928 < 0.001 MMSE at Postop Day 7 (score, mean ± SD) 26.85 ± 2.13 24.12 ± 2.36 t = 7.542 < 0.001 Time to First Flatus (h, mean ± SD) 28.56 ± 6.32 42.18 ± 8.57 t=-12.364 < 0.001 Time to First Ambulation (h, mean ± SD) 32.14 ± 7.58 58.36 ± 10.24 t=-19.875 < 0.001 Hospitalization Cost (¥, mean ± SD) 38652.47 ± 8562.31 46895.72 ± 10246.58 t=-5.682 < 0.001 3.4 Multivariate Logistic Regression Analysis for Postoperative Complications Variables with P < 0.1 in univariate analysis (age, ASA class, surgery type, intervention type) were included. Multivariate analysis showed that ERAS multidisciplinary intervention was an independent protective factor (OR = 0.382, 95%CI: 0.186–0.785, P = 0.009), while ASA class III-IV was an independent risk factor (OR = 2.456, 95%CI: 1.213–4.974, P = 0.012) for postoperative complications (Table 8 ). Table 8 Multivariate Logistic Regression Analysis for Postoperative Complications Variable Regression Coefficient Standard Error Wald χ² P-value OR (95% CI) Variable Age (≥ 75 vs < 75 years) 0.582 0.326 3.158 0.076 1.780 0.952–3.330 ASA Class (III-IV vs II) 0.898 0.364 6.125 0.012 2.456 1.213–4.974 Surgery Type (Major vs Minor/Intermediate) 0.465 0.312 2.248 0.134 1.592 0.887–2.865 Intervention (ERAS MDT vs Conventional) -0.962 0.368 6.874 0.009 0.382 0.186–0.785 Constant -1.245 0.486 6.528 0.011 0.287 -- 4. Discussion 4.1 Impact of Multidisciplinary ERAS Intervention on Postoperative Complications in Frail Elderly Patients This study found a significantly lower total postoperative complication rate in the Control Group (15.96% vs. 32.61%), particularly for pulmonary infection, delirium, and surgical site infection. This aligns with recent research; a 2024 systematic review reported a 44% reduction in major complication risk with multimodal prehabilitation[18], and Fuwai Hospital's study confirmed preoperative frailty as an independent risk factor for pulmonary complications (OR = 1.998)[19]. Potential mechanisms include: 1) Prehabilitation physical training enhances respiratory muscle strength and pulmonary reserve[20]; nutritional support improves tissue repair. 2) Intraoperative temperature protection maintains immune function[11]. 3) Multimodal analgesia reduces opioid-related respiratory depression and delirium risk[12]; early mobilization aids pulmonary recovery. 4) Geriatrician-led comorbidity and medication optimization reduces adverse drug events. The lack of significant difference in anastomotic leakage and DVT rates may relate to sample size, suggesting need for enhanced measures like strict glycemic control, precise fluid management, and standardized anticoagulation. 4.2 Impact of Multidisciplinary ERAS Intervention on Patient Recovery and Functional Restoration The Control Group had significantly shorter hospital and ICU stays, and earlier time to flatus and ambulation. This validates the ERAS core principle of promoting recovery through optimized perioperative workflows. Preoperative carbohydrates reduce insulin resistance and discomfort[21]; early feeding and mobilization synergistically enhance recovery. The Control Group also showed superior 6MWT distance and MMSE scores at day 7, indicating benefits for both physical and cognitive function. Prehabilitation builds strength for early mobilization. Precise anesthesia depth control, effective pain management, and cognitive monitoring reduce central nervous system stress and delirium risk[17]. Protecting cognitive function is crucial for enabling elderly patients' return to family and society, embodying a patient-centered approach. 4.3 Economic Value and Clinical Implications Lower hospitalization costs and 30-day readmission rates in the Control Group demonstrate clear economic value. Reducing complications and length of stay decreases direct costs, while lower readmission rates alleviate patient and systemic burden. This aligns with a 2025 systematic review highlighting prehabilitation's role in efficient resource use[22]. The constructed multidisciplinary model is practical, leveraging expertise from surgery, anesthesia, nutrition, rehabilitation, geriatrics, and nursing, ensuring coordinated, precise, and continuous care. The protocol was adapted for frail elderly patients (e.g., extended prehabilitation, simplified prep, cognitive protection) to ensure safety and tolerability. 4.4 Limitations and Future Directions Limitations include: 1) Non-randomized design risk of selection bias, needing RCT confirmation; 2) Relatively small sample size may affect power for rare complications; 3) Short follow-up lacking long-term outcomes (e.g., 1-year survival, quality of life). Future research should: 1) Conduct large, multicenter RCTs for long-term validation; 2) Develop standards for individualized prehabilitation based on frailty/surgery type; 3) Establish quality control systems for ERAS in frail elderly; 4) Investigate molecular mechanisms (e.g., inflammatory markers, mitochondrial function). 5. Conclusion The multidisciplinary intervention model under the ERAS concept significantly reduces postoperative complications, shortens hospital and ICU stay, promotes physical and cognitive recovery, and lowers costs and readmission rates in frail elderly gastrectomy patients[24]. It is a safe, effective, and economically valuable perioperative management strategy. By integrating multidisciplinary expertise for comprehensive care from prehabilitation to postoperative recovery, it fully embodies a patient-centered approach and deserves wider clinical adoption. Declarations Acknowledgments This study was financially supported by the Tianjin Health Information Society(TJHIA-2026-014). Authors’ Contributions Study conception and manuscript drafting by Chunhong Niu; Data interpretation, collection, and case provision by Yijuan Feng. Availability of data and materials The EHR dataset used during and/or analyzed during the current study are not publicly available due to our IRB policy but are available from the corresponding author upon reasonable request. Ethics approval and consent to participate The study was approved by the Institutional Review Board (IRB) of Tianjin Fourth Central Hospital (reference number SZXLL-2025-KY037). All the participants provided written informed consent. Consent for publication Not applicable. Competing interests (1) All authors declare that they have no competing interest. References Ministry of Civil Affairs. (2024). 2023 Statistical Bulletin on Civil Affairs Development. China Civil Affairs , (9), 40-45. 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Early mobilization protocol in enhanced recovery after surgery for frail older adults: A quality improvement project. Journal of Nursing Management , 31(7), 1982-1991. Smith, A., Jones, D., Brown, C., et al. (2024). Enhanced recovery after surgery for frail older adults: A systematic review and meta-analysis. British Journal of Surgery , 111(5), 489-500. Brown, A., Smith, D., Wilson, E., et al. (2024). Frailty and postoperative cognitive dysfunction: A prospective cohort study. Age and Ageing , 53(3), 542-549. Kuemmerli, C., et al. (2024). Effect of enhanced recovery after surgery strategies on short-term outcomes in patients aged 70 years and older undergoing pancreaticoduodenectomy: A systematic review and individual patient data meta-analysis. Journal of Hepato-Biliary-Pancreatic Sciences , 31(11), 892-901. Feng, X., Zhang, C., Li, L., et al. (2025). Correlation between preoperative frailty and postoperative pulmonary complications in elderly cardiac surgery patients. Chinese Circulation Journal , 40(7), 689-693. (In Chinese) Chen, L., Wang, J., Liu, Y., et al. (2024). Prehabilitation in frail older adults scheduled for major abdominal surgery: A randomized controlled trial. Journal of the American College of Surgeons , 238(3), e195-e204. National Institute for Health and Care Excellence (NICE). (2022). Enhanced recovery after surgery: NICE guideline [NG193] . London: NICE. Zhao, Y., Sun, Y., & Zhou, J. (2025). Application effect and health economic evaluation of prehabilitation in patients undergoing major gastrointestinal cancer surgery. Chinese Journal of Gastrointestinal Surgery , 28(6), 543-549. (In Chinese) European Society for Clinical Nutrition and Metabolism (ESPEN). (2022). Guidelines on clinical nutrition in the elderly. Clinical Nutrition , 41(3), 528-554. Wang, Y., Li, X., Zhang, H., et al. (2023). Multidisciplinary enhanced recovery after surgery program improves outcomes in elderly patients with frailty undergoing abdominal surgery: A prospective cohort study. Aging Clinical and Experimental Research , 35(8), 2145-2153. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 19 Apr, 2026 Reviews received at journal 31 Mar, 2026 Reviewers agreed at journal 30 Mar, 2026 Reviewers agreed at journal 29 Mar, 2026 Reviewers invited by journal 16 Mar, 2026 Editor assigned by journal 12 Feb, 2026 Submission checks completed at journal 12 Feb, 2026 First submitted to journal 27 Jan, 2026 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. 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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-8706174","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":606739903,"identity":"8d3c66fd-72fe-4053-b765-ccda989fcbf7","order_by":0,"name":"Chunhong Niu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBklEQVRIiWNgGAWjYDACZjBiSABixgcSBhI8/OyNjQ8+EKmF2cCiwEZOsudws+EMwhaBtbBJVHxIMza4kd4mzYFHuTk7j+HnwrY7efzS7ZcNbhgcTtxw82GDNAODnZxuA3Ytls08xtIz254VS845U/hwBlDLzNuJDcYFDMnGZgewazE4zGPGzNsGNPxGTrKxBFBLH1BL8gyGA4nbiNCSJv0HqKXh5sGGwzzEaUk/JiFhkGYscIOxsRm/FrZiaZ5zQC/MyGE2kDAABXJiM+MMAzx+OX9442eessOJ/RLpDx9I/AFF5fHnPz5U2Mnh0oIEeAyQjSKoHATYHxClbBSMglEwCkYeAADu02VGVf3xJQAAAABJRU5ErkJggg==","orcid":"","institution":"Tianjin Fourth Central Hospital","correspondingAuthor":true,"prefix":"","firstName":"Chunhong","middleName":"","lastName":"Niu","suffix":""},{"id":606739905,"identity":"96cfdea7-6680-49ee-b40b-e3bc0ce0f010","order_by":1,"name":"Xinrui Zhang","email":"","orcid":"","institution":"Qiqihar Medical College","correspondingAuthor":false,"prefix":"","firstName":"Xinrui","middleName":"","lastName":"Zhang","suffix":""},{"id":606739907,"identity":"6220a9d3-ab94-4c7e-b00e-8c46084a5ed8","order_by":2,"name":"Yijuan Feng","email":"","orcid":"","institution":"Tianjin Fourth Central Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yijuan","middleName":"","lastName":"Feng","suffix":""}],"badges":[],"createdAt":"2026-01-27 05:53:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8706174/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8706174/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104960011,"identity":"27ddf892-57fd-4ef5-ad37-fd7c59e658cd","added_by":"auto","created_at":"2026-03-19 08:46:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1310750,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8706174/v1/e7577f6b-b146-4600-976f-08709fcd3466.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Impact of Multidisciplinary Intervention Under the Concept of ERAS on the Prognosis of Frail Elderly Patients Undergoing Gastrectomy","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eThe global aging process is accelerating. The proportion of the elderly people aged 60 and over exceeding 18% in China[1]. The number of elderly surgical patients is increasing year by year. Gastrectomy, a common surgical procedure, poses a high risk of postoperative complications for elderly patients due to degenerative physiological changes and decreased functional reserve of multiple organs[2]. Frailty, a syndrome specific to the elderly characterized by reduced physiological reserve and decreased stress tolerance, is often associated with sarcopenia, cognitive decline, and multiple comorbidities, significantly increasing the risk of adverse postoperative outcomes. The Enhanced Recovery After Surgery (ERAS) concept, proposed by Danish surgeon Kehlet in the 1990s, optimizes perioperative care by integrating evidence-based measures to reduce surgical trauma and stress response, thereby decreasing complications and shortening hospital stays[3]. While widely applied in general surgery, the direct application of traditional ERAS protocols to frail elderly patients is challenging due to their unique physiological status and multiple comorbidities. The multidisciplinary collaborative model, integrating expertise from surgery, anesthesia, nutrition, rehabilitation, and other fields to provide individualized treatment plans, is an effective approach to address perioperative management challenges in frail elderly patients[4].\u003c/p\u003e \u003cp\u003eCurrent research indicates a significant positive correlation between frailty and postoperative complication and mortality rates in elderly patients. Research by Feng Xue et al. from Fuwai Hospital found that preoperative frailty nearly doubled the risk of postoperative pulmonary complications (OR\u0026thinsp;=\u0026thinsp;1.998) and significantly prolonged mechanical ventilation and ICU stay in elderly cardiac surgery patients[5]. In the field of gastrectomy, frail patients have significantly higher rates of postoperative delirium, infection, and anastomotic leakage compared to non-frail patients[6], with hospital stays prolonged by over 30%. Prehabilitation, a key component of ERAS preoperative management, has been proven to improve surgical tolerance in frail patients. A 2024 systematic review and meta-analysis of 16 studies involving 3339 patients showed that multimodal prehabilitation could reduce the risk of major complications after major abdominal surgery in frail patients by 44%, shorten hospital stay by 1 day, and significantly increase the 6-minute walk distance[7]. However, clinical standardized protocols for ERAS-based multidisciplinary intervention are still lacking in frail elderly gastrectomy patients. It limits the full potential of such interventions.\u003c/p\u003e \u003cp\u003eThis study aims to establish a prospective cohort to evaluate the impact of a constructed multidisciplinary intervention model based on the ERAS concept on postoperative complications, hospital stay, functional recovery, and other prognostic indicators in frail elderly gastrectomy patients, thereby optimizing perioperative management strategies. The findings will provide evidence-based support for the clinical management of this patient population, promote the standardized application of the ERAS concept in the frail elderly, and hold significant value for clinical translation and practical guidance.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study Participants\u003c/h2\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003ch2\u003e2.1.1 Inclusion Criteria:\u003c/h2\u003e \u003cp\u003e① Age\u0026thinsp;\u0026ge;\u0026thinsp;60 years, meeting the WHO definition of elderly; ② Scheduled for elective gastrectomy; ③ Preoperatively assessed as frail using the Fried Frailty Phenotype (meeting 3 or more of the 5 criteria: weight loss, exhaustion, low grip strength, slow walking speed, low physical activity); ④ American Society of Anesthesiologists (ASA) physical status classification II-IV[8]; ⑤ Informed consent obtained from patients and family members; ⑥ Expected survival\u0026thinsp;\u0026ge;\u0026thinsp;6 months, able to cooperate with postoperative follow-up assessments.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003e2.1.2 Exclusion Criteria:\u003c/h2\u003e \u003cp\u003e① Severe cardiovascular or cerebrovascular diseases (e.g., acute myocardial infarction, acute cerebral hemorrhage); ② Severe cognitive impairment (Mini-Mental State Examination (MMSE) score\u0026thinsp;\u0026lt;\u0026thinsp;17); ③ Pre-existing severe infection or multiple organ failure; ④ Conversion to emergency surgery or major change in surgical procedure; ⑤ Refusal to participate in the multidisciplinary intervention or poor follow-up compliance; ⑥ Advanced malignant tumors or other terminal diseases.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.1.3 Dropout Criteria:\u003c/h2\u003e \u003cp\u003e① Withdrawal due to changes in condition during the study; ② Missing key data affecting outcome assessment; ③ Lost to follow-up within 30 days postoperatively.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Study Methods\u003c/h2\u003e \u003cp\u003e\u003cb\u003e2.2.1 Study Design and Grouping\u003c/b\u003e: A prospective cohort study design was used. Frail elderly patients scheduled for elective gastrectomy in the General Surgery and Hepatobiliary Surgery departments of our hospital were consecutively enrolled from January 2022 to June 2024. Based on the establishment timeline of the hospital's ERAS multidisciplinary team and clinical intervention implementation, patients enrolled before April 2023 received conventional perioperative management (Conventional Group), while those enrolled after April 2023 received the ERAS-based multidisciplinary intervention (Control Group). Informed consent was obtained from all participants.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003e2.2.2 Conventional Group Intervention:\u003c/h2\u003e \u003cp\u003eThis group adopts the traditional perioperative management mode, and the specific management process is shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\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\u003eThe specific management process of the traditional perioperative management mode\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical Stage\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eManagement Approach\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePreoperative Assessment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRoutine history taking, physical examination, and laboratory. tests; surgical risk assessment performed solely by the surgeon.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePreoperative Preparation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFasting for 8 hours, clear liquids until 6 hours preoperatively. routine bowel preparation; skin preparation one day before surgery.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIntraoperative Management\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eConventional anesthesia protocol; drainage tubes placed as needed; no standardized temperature protection.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePostoperative Management\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnalgesia on demand (primarily opioids); fasting until passage of flatus, then gradual diet advancement; bed rest until drain removal, then initiation of ambulation; routine nursing guidance.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003e2.2.3 Control Group Intervention:\u003c/h2\u003e \u003cp\u003eA multidisciplinary team (MDT) consisting of surgeons, anesthesiologists, nutritionists, rehabilitation therapists, geriatricians, and ERAS specialist nurses was established. Referring to the \u003cem\u003eExpert Consensus on Enhanced Recovery After Surgery for Elderly Patients\u003c/em\u003e[9], an ERAS intervention protocol was implemented(Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\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\u003eERAS intervention protocol\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical Stage\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eManagement Approach\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePreoperative Assessment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMDT joint assessment within 24h of admission: Comprehensive Geriatric Assessment including frailty (Fried scale), nutritional risk (NRS-2002), cognitive function (MMSE), sarcopenia (psoas muscle area at L3 level), and comorbidities. Individualized intervention plan formulated by the MDT.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePreoperative Preparation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRegular diet until 1 day before surgery; oral carbohydrate drink (400ml) 2h preoperatively; no routine bowel preparation (except for colorectal surgery); no routine skin shaving[11].\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIntraoperative Management\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eAnesthesia\u003c/b\u003e:\u0026nbsp;Combined general anesthesia with epidural block to reduce opioid use; continuous Bispectral Index (BIS) monitoring maintaining depth between 40\u0026ndash;60.\u003c/p\u003e \u003cp\u003e\u003cb\u003eTemperature Protection\u003c/b\u003e:\u0026nbsp;Pre-warming of OR (24\u0026ndash;26\u0026deg;C), forced-air warming blanket, warmed intravenous fluids and irrigation fluids (37\u0026deg;C) to maintain core temperature\u0026thinsp;\u0026ge;\u0026thinsp;36\u0026deg;C[12].\u003c/p\u003e \u003cp\u003e\u003cb\u003eMinimally Invasive \u0026amp; Drain Strategy\u003c/b\u003e:\u0026nbsp;Laparoscopic approach prioritized; abdominal drains placed only when necessary, with clear removal criteria (drainage \u0026lt;\u0026thinsp;100ml/24h and not turbid within 24-48h postop).\u003c/p\u003e \u003cp\u003e\u003cb\u003eFluid Management\u003c/b\u003e:\u0026nbsp;Goal-directed fluid therapy to maintain urine output\u0026thinsp;\u0026ge;\u0026thinsp;0.5 ml/kg/h, reducing risk of fluid overload.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePostoperative Management\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMultimodal Analgesia\u003c/b\u003e:\u0026nbsp;Combination of \"NSAID\u0026thinsp;+\u0026thinsp;opioid\u0026thinsp;+\u0026thinsp;nerve block\"; patient-controlled analgesia pump for first 48h, target pain NRS score\u0026thinsp;\u0026le;\u0026thinsp;3[13].\u003c/p\u003e \u003cp\u003e\u003cb\u003eEarly Feeding \u0026amp; Nutrition\u003c/b\u003e:\u0026nbsp;Sips of water at 6h postop, liquid diet at 12h, advancing to normal diet; continued high-protein nutritional support until postoperative day 7[14].\u003c/p\u003e \u003cp\u003e\u003cb\u003eEarly Mobilization\u003c/b\u003e:\u0026nbsp;Assisted bed turning and limb movement within 24h; standing within 48h; gradually increasing activity with goal of \u0026ge;\u0026thinsp;30 minutes daily by postoperative day 7[15].\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAdditional specific interventions for the Control Group included as shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAdditional specific interventions\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical Stage\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eManagement Approach\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePrehabilitation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNutrition\u003c/b\u003e[10]: For NRS-2002\u0026thinsp;\u0026ge;\u0026thinsp;3, high-protein supplements (1.2-1.5g/kg/day); anemia correction preoperatively (target Hb\u0026ge;120g/L).\u003c/p\u003e \u003cp\u003e\u003cb\u003ePhysical Training\u003c/b\u003e:\u0026nbsp;Individualized exercise plan including 30min daily aerobic training (e.g., indoor walking), lower limb strength training (5-time sit-to-stand test), and respiratory training for 2\u0026ndash;4 weeks.\u003c/p\u003e \u003cp\u003e\u003cb\u003eMedication Optimization\u003c/b\u003e:\u0026nbsp;Geriatrician-led medication review, deprescribing/adjusting high-risk drugs.\u003c/p\u003e \u003cp\u003e\u003cb\u003ePsychological Support\u003c/b\u003e:\u0026nbsp;Counseling for anxiety to improve compliance.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComplication Prevention\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDaily geriatrician rounds for cognitive monitoring/delirium prevention; respiratory training guided by physiotherapist to prevent pulmonary infection.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDischarge \u0026amp; Continuity of Care\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePost-discharge rehabilitation plan (home exercise, nutrition, medication list); telephone follow-up or outpatient review at 1 week, 2 weeks, and 1 month postoperatively.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003e2.2.4 Outcome Measures:\u003c/h2\u003e \u003cp\u003eThe surgical assessment indicators are shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, which are divided into primary outcome indicators and secondary outcome indicators.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe surgical assessment indicators\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eindicator name\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIndicator content\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary Outcome Measures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative total complication rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe severity of complications such as pulmonary infection, postoperative delirium, incision infection, anastomotic leakage, and lower limb deep vein thrombosis was evaluated using Clavien Dindo grading system [16];\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative hospital length of stay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003edays from surgery to discharge\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30-day readmission rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eproportion readmitted for surgery-related complications within 30 days\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary Outcome Measures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eICU stay time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe number of days of ICU stay after surgery.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative functional recovery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eassessed preoperatively and at postoperative day 7 using the 6-Minute Walk Test (6MWT) for physical function and MMSE for cognitive function[17].\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative recovery indicators\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTime to first flatus, time to first ambulation.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ehospitalization expenses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe total medical expenses of the patient's hospitalization this time.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section3\"\u003e \u003ch2\u003e2.2.5 Data Collection and Quality Control:\u003c/h2\u003e \u003cp\u003eTwo trained research nurses collected data using standardized forms. A third-party researcher performed double-checking. All scale assessments were performed by certified professionals.\u003c/p\u003e \u003cp\u003e \u003cb\u003e2.3 Statistical Analysis\u003c/b\u003e: SPSS 26.0 was used. Normally distributed continuous data are presented as mean (\u0026plusmn;\u0026thinsp;SD) and compared using independent samples t-test; non-normally distributed data as median (IQR) and compared using Wilcoxon rank-sum test. Categorical data are presented as n (%) and compared using χ\u0026sup2; or Fisher's exact test. Multivariate logistic regression identified independent factors for postoperative complications. P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Comparison of Baseline Characteristics\u003c/h2\u003e \u003cp\u003e186 patients were enrolled (Control: n\u0026thinsp;=\u0026thinsp;94; Conventional: n\u0026thinsp;=\u0026thinsp;92). No significant differences were found in gender, age, BMI, ASA class, surgery type, comorbidities, or preoperative frailty score between groups (all P\u0026thinsp;\u0026gt;\u0026thinsp;0.05), indicating comparability (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Baseline Characteristics Between Groups\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=\"left\" 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=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl Group (n\u0026thinsp;=\u0026thinsp;94)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eConventional Group (n\u0026thinsp;=\u0026thinsp;92)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStatistic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender (Male/Female, n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53/41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51/41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u0026sup2;=0.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.838\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e72.65\u0026thinsp;\u0026plusmn;\u0026thinsp;5.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73.18\u0026thinsp;\u0026plusmn;\u0026thinsp;5.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et=-0.624\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.533|\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u0026sup2;, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.14\u0026thinsp;\u0026plusmn;\u0026thinsp;2.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.86\u0026thinsp;\u0026plusmn;\u0026thinsp;3.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;0.621\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.535\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASA Class (n, %)\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 \u003cp\u003eχ\u0026sup2;=0.365\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.833\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClass II\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38(40.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36(39.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\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\u003eClass III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45(47.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46(50.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\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\u003eClass IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11(11.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(10.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\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 Type (n, %)\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 \u003cp\u003eχ\u0026sup2;=1.246\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.742\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGastrointestinal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42(44.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39(42.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\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\u003eHepatobiliary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31(32.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33(35.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\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\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21(22.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20(21.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\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\u003eComorbidities (n, %)\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\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56(59.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54(58.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u0026sup2;=0.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.896\u003c/p\u003e \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 \u003cp\u003e32(34.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30(32.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u0026sup2;=0.045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.832\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoronary Heart Disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24(25.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23(25.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u0026sup2;=0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.933\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreop Fried Score (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.92\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;0.472\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.638\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreop 6MWT (m, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e285.36\u0026thinsp;\u0026plusmn;\u0026thinsp;42.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e281.54\u0026thinsp;\u0026plusmn;\u0026thinsp;45.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;0.628\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.531\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreop MMSE (score, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.68\u0026thinsp;\u0026plusmn;\u0026thinsp;2.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.32\u0026thinsp;\u0026plusmn;\u0026thinsp;2.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;0.987\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.325\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Comparison of Primary Outcomes\u003c/h2\u003e \u003cp\u003eThe total postoperative complication rate was significantly lower in the Control Group (15.96%, 15/94) vs. the Conventional Group (32.61%, 30/92) (P\u0026thinsp;=\u0026thinsp;0.006). Specifically, rates of pulmonary infection, postoperative delirium, and surgical site infection were significantly lower in the Control Group (all P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). No significant differences were found for anastomotic leakage or DVT (both P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Postoperative hospital stay was shorter in the Control Group (7.24\u0026thinsp;\u0026plusmn;\u0026thinsp;2.16 days vs. 10.58\u0026thinsp;\u0026plusmn;\u0026thinsp;3.27 days, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The 30-day readmission rate was lower in the Control Group (3.19% vs. 10.87%, P\u0026thinsp;=\u0026thinsp;0.032) (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Primary Outcome Measures Between Groups\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=\"left\" 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\" colname=\"c1\"\u003e \u003cp\u003eOutcome Measure\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl Group (n\u0026thinsp;=\u0026thinsp;94)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eConventional Group (n\u0026thinsp;=\u0026thinsp;92)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStatistic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal Complications (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15(15.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30(32.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u0026sup2;=7.523\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePulmonary Infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(4.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13(14.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u0026sup2;=6.058\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative Delirium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(5.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(16.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u0026sup2;=6.874\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical Site Infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(2.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(9.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eχ\u0026sup2;=5.126\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnastomotic Leakage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(2.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(3.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u0026sup2;=0.238\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.626\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeep Vein Thrombosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(2.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(2.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u0026sup2;=0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.992\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostop Hospital Stay (days, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.24\u0026thinsp;\u0026plusmn;\u0026thinsp;2.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.58\u0026thinsp;\u0026plusmn;\u0026thinsp;3.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et=-8.142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30-day Readmission Rate (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(3.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(10.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u0026sup2;=4.572\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Comparison of Secondary Outcomes\u003c/h2\u003e \u003cp\u003eICU stay was shorter in the Control Group (1.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85 days vs. 2.36\u0026thinsp;\u0026plusmn;\u0026thinsp;1.42 days, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). At postoperative day 7, the Control Group had longer 6MWT distance (326.54\u0026thinsp;\u0026plusmn;\u0026thinsp;48.72m vs. 291.36\u0026thinsp;\u0026plusmn;\u0026thinsp;45.87m, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and higher MMSE scores (26.85\u0026thinsp;\u0026plusmn;\u0026thinsp;2.13 vs. 24.12\u0026thinsp;\u0026plusmn;\u0026thinsp;2.36, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Time to first flatus, time to first ambulation were earlier, and total hospitalization costs were lower in the Control Group (all P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Secondary Outcome Measures Between Groups\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=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" 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=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutcome Measure\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl Group (n\u0026thinsp;=\u0026thinsp;94)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eConventional Group (n\u0026thinsp;=\u0026thinsp;92)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStatistic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eICU Stay (days, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.36\u0026thinsp;\u0026plusmn;\u0026thinsp;1.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et=-8.265\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6MWT at Postop Day 7 (m, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e326.54\u0026thinsp;\u0026plusmn;\u0026thinsp;48.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e291.36\u0026thinsp;\u0026plusmn;\u0026thinsp;45.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;4.928\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMMSE at Postop Day 7 (score, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e26.85\u0026thinsp;\u0026plusmn;\u0026thinsp;2.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e24.12\u0026thinsp;\u0026plusmn;\u0026thinsp;2.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;7.542\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime to First Flatus (h, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e28.56\u0026thinsp;\u0026plusmn;\u0026thinsp;6.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e42.18\u0026thinsp;\u0026plusmn;\u0026thinsp;8.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et=-12.364\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime to First Ambulation (h, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e32.14\u0026thinsp;\u0026plusmn;\u0026thinsp;7.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e58.36\u0026thinsp;\u0026plusmn;\u0026thinsp;10.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et=-19.875\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospitalization Cost (\u0026yen;, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e38652.47\u0026thinsp;\u0026plusmn;\u0026thinsp;8562.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e46895.72\u0026thinsp;\u0026plusmn;\u0026thinsp;10246.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et=-5.682\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Multivariate Logistic Regression Analysis for Postoperative Complications\u003c/h2\u003e \u003cp\u003eVariables with P\u0026thinsp;\u0026lt;\u0026thinsp;0.1 in univariate analysis (age, ASA class, surgery type, intervention type) were included. Multivariate analysis showed that ERAS multidisciplinary intervention was an independent protective factor (OR\u0026thinsp;=\u0026thinsp;0.382, 95%CI: 0.186\u0026ndash;0.785, P\u0026thinsp;=\u0026thinsp;0.009), while ASA class III-IV was an independent risk factor (OR\u0026thinsp;=\u0026thinsp;2.456, 95%CI: 1.213\u0026ndash;4.974, P\u0026thinsp;=\u0026thinsp;0.012) for postoperative complications (Table\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate Logistic Regression Analysis for Postoperative Complications\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" 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=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRegression Coefficient\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStandard Error\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWald χ\u0026sup2;\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (\u0026ge;\u0026thinsp;75 vs\u0026thinsp;\u0026lt;\u0026thinsp;75 years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.582\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.326\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.158\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.076\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.780\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.952\u0026ndash;3.330\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASA Class (III-IV vs II)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.898\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.364\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.456\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.213\u0026ndash;4.974\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgery Type (Major vs Minor/Intermediate)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.465\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.312\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.248\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.592\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.887\u0026ndash;2.865\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntervention (ERAS MDT vs Conventional)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.962\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.368\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.874\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.382\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.186\u0026ndash;0.785\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-1.245\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.486\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.528\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.287\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Impact of Multidisciplinary ERAS Intervention on Postoperative Complications in Frail Elderly Patients\u003c/h2\u003e \u003cp\u003eThis study found a significantly lower total postoperative complication rate in the Control Group (15.96% vs. 32.61%), particularly for pulmonary infection, delirium, and surgical site infection. This aligns with recent research; a 2024 systematic review reported a 44% reduction in major complication risk with multimodal prehabilitation[18], and Fuwai Hospital's study confirmed preoperative frailty as an independent risk factor for pulmonary complications (OR\u0026thinsp;=\u0026thinsp;1.998)[19]. Potential mechanisms include: 1) Prehabilitation physical training enhances respiratory muscle strength and pulmonary reserve[20]; nutritional support improves tissue repair. 2) Intraoperative temperature protection maintains immune function[11]. 3) Multimodal analgesia reduces opioid-related respiratory depression and delirium risk[12]; early mobilization aids pulmonary recovery. 4) Geriatrician-led comorbidity and medication optimization reduces adverse drug events. The lack of significant difference in anastomotic leakage and DVT rates may relate to sample size, suggesting need for enhanced measures like strict glycemic control, precise fluid management, and standardized anticoagulation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Impact of Multidisciplinary ERAS Intervention on Patient Recovery and Functional Restoration\u003c/h2\u003e \u003cp\u003eThe Control Group had significantly shorter hospital and ICU stays, and earlier time to flatus and ambulation. This validates the ERAS core principle of promoting recovery through optimized perioperative workflows. Preoperative carbohydrates reduce insulin resistance and discomfort[21]; early feeding and mobilization synergistically enhance recovery. The Control Group also showed superior 6MWT distance and MMSE scores at day 7, indicating benefits for both physical and cognitive function. Prehabilitation builds strength for early mobilization. Precise anesthesia depth control, effective pain management, and cognitive monitoring reduce central nervous system stress and delirium risk[17]. Protecting cognitive function is crucial for enabling elderly patients' return to family and society, embodying a patient-centered approach.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Economic Value and Clinical Implications\u003c/h2\u003e \u003cp\u003eLower hospitalization costs and 30-day readmission rates in the Control Group demonstrate clear economic value. Reducing complications and length of stay decreases direct costs, while lower readmission rates alleviate patient and systemic burden. This aligns with a 2025 systematic review highlighting prehabilitation's role in efficient resource use[22]. The constructed multidisciplinary model is practical, leveraging expertise from surgery, anesthesia, nutrition, rehabilitation, geriatrics, and nursing, ensuring coordinated, precise, and continuous care. The protocol was adapted for frail elderly patients (e.g., extended prehabilitation, simplified prep, cognitive protection) to ensure safety and tolerability.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003e4.4 Limitations and Future Directions\u003c/h2\u003e \u003cp\u003eLimitations include: 1) Non-randomized design risk of selection bias, needing RCT confirmation; 2) Relatively small sample size may affect power for rare complications; 3) Short follow-up lacking long-term outcomes (e.g., 1-year survival, quality of life).\u003c/p\u003e \u003cp\u003eFuture research should: 1) Conduct large, multicenter RCTs for long-term validation; 2) Develop standards for individualized prehabilitation based on frailty/surgery type; 3) Establish quality control systems for ERAS in frail elderly; 4) Investigate molecular mechanisms (e.g., inflammatory markers, mitochondrial function).\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThe multidisciplinary intervention model under the ERAS concept significantly reduces postoperative complications, shortens hospital and ICU stay, promotes physical and cognitive recovery, and lowers costs and readmission rates in frail elderly gastrectomy patients[24]. It is a safe, effective, and economically valuable perioperative management strategy. By integrating multidisciplinary expertise for comprehensive care from prehabilitation to postoperative recovery, it fully embodies a patient-centered approach and deserves wider clinical adoption.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was financially supported by the Tianjin Health Information Society(TJHIA-2026-014).\u003cbr\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudy conception and manuscript drafting by Chunhong Niu; Data interpretation, collection, and case provision by Yijuan Feng.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe EHR dataset used during and/or analyzed during the current study are not publicly available due to our IRB policy but are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Institutional Review Board (IRB) of Tianjin Fourth Central Hospital (reference number SZXLL-2025-KY037). All the participants provided written informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003cbr\u003e(1) All authors declare that they have no competing interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMinistry of Civil Affairs. (2024). 2023 Statistical Bulletin on Civil Affairs Development. \u003cem\u003eChina Civil Affairs\u003c/em\u003e, (9), 40-45. (In Chinese)\u003c/li\u003e\n\u003cli\u003eGeriatrics Branch of Chinese Medical Association, Geriatrics Physician Branch of Chinese Medical Doctor Association. (2023). Chinese Expert Consensus on Perioperative Safety Management in Elderly Patients (2023 Edition). \u003cem\u003eChinese Journal of Geriatrics\u003c/em\u003e, 42(10), 1173-1182. (In Chinese)\u003c/li\u003e\n\u003cli\u003eKehlet, H. (1997). Multimodal approach to control postoperative pathophysiology and rehabilitation. \u003cem\u003eBritish Journal of Anaesthesia\u003c/em\u003e, 78(5), 606-617.\u003c/li\u003e\n\u003cli\u003eWang, Y., Li, J., \u0026amp; Zhang, H. (2024). Research progress on rapid recovery in elderly perioperative patients. \u003cem\u003eChinese Journal of Geriatrics\u003c/em\u003e, 43(11), 1321-1325. (In Chinese)\u003c/li\u003e\n\u003cli\u003eFeng, X., Zhang, C., \u0026amp; Li, L. (2025). Correlation between preoperative frailty and postoperative pulmonary complications in elderly cardiac surgery patients. \u003cem\u003eChinese Circulation Journal\u003c/em\u003e, 40(7), 689-693. (In Chinese)\u003c/li\u003e\n\u003cli\u003eDing, B., Zhang, L., \u0026amp; Wang, M. (2024). Effect of ERAS-based nursing during anesthesia recovery on postoperative delirium in elderly patients undergoing total hip arthroplasty under general anesthesia. \u003cem\u003eChinese Journal of Nursing\u003c/em\u003e, 59(11), 1312-1316. (In Chinese)\u003c/li\u003e\n\u003cli\u003eChen, L., Liu, Y., \u0026amp; Wang, J. (2024). Systematic review and Meta-analysis of preoperative multimodal prehabilitation on the prognosis of frail elderly patients undergoing major abdominal surgery. \u003cem\u003eChinese Journal of General Surgery\u003c/em\u003e, 39(4), 265-270. (In Chinese)\u003c/li\u003e\n\u003cli\u003eAmerican College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). (2023). Frailty assessment in surgical patients: 2023 update. \u003cem\u003eBulletin of the American College of Surgeons\u003c/em\u003e, 108(4), 32-38.\u003c/li\u003e\n\u003cli\u003eChinese Society of Enhanced Recovery After Surgery. (2023). Expert consensus on enhanced recovery after surgery for elderly patients. \u003cem\u003eChinese Journal of Surgery\u003c/em\u003e, 61(2), 101-108. (In Chinese)\u003c/li\u003e\n\u003cli\u003eEuropean Society for Clinical Nutrition and Metabolism (ESPEN). (2022). Guidelines on clinical nutrition in the elderly. \u003cem\u003eClinical Nutrition\u003c/em\u003e, 41(3), 528-554.\u003c/li\u003e\n\u003cli\u003eNational Institute for Health and Care Excellence (NICE). (2022). \u003cem\u003eEnhanced recovery after surgery: NICE guideline [NG193]\u003c/em\u003e. London: NICE.\u003c/li\u003e\n\u003cli\u003eZhang, M., Li, Y., Zhao, J., et al. (2023). Effect of intraoperative temperature management on postoperative complications in frail elderly patients: A secondary analysis of a randomized trial. \u003cem\u003eAnaesthesia\u003c/em\u003e, 78(5), 621-629.\u003c/li\u003e\n\u003cli\u003eLiu, H., Chen, J., Wang, L., et al. (2024). Multimodal analgesia reduces postoperative delirium in frail elderly patients undergoing abdominal surgery. \u003cem\u003ePain Practice\u003c/em\u003e, 24(2), 189-197.\u003c/li\u003e\n\u003cli\u003eKim, H., Lee, S., Park, J., et al. (2023). Effect of early enteral nutrition on postoperative recovery in frail elderly patients: A randomized controlled trial. \u003cem\u003eJPEN Journal of Parenteral and Enteral Nutrition\u003c/em\u003e, 47(5), 689-697.\u003c/li\u003e\n\u003cli\u003eLi, S., Zhang, Q., He, Y., et al. (2023). Early mobilization protocol in enhanced recovery after surgery for frail older adults: A quality improvement project. \u003cem\u003eJournal of Nursing Management\u003c/em\u003e, 31(7), 1982-1991.\u003c/li\u003e\n\u003cli\u003eSmith, A., Jones, D., Brown, C., et al. (2024). Enhanced recovery after surgery for frail older adults: A systematic review and meta-analysis. \u003cem\u003eBritish Journal of Surgery\u003c/em\u003e, 111(5), 489-500.\u003c/li\u003e\n\u003cli\u003eBrown, A., Smith, D., Wilson, E., et al. (2024). Frailty and postoperative cognitive dysfunction: A prospective cohort study. \u003cem\u003eAge and Ageing\u003c/em\u003e, 53(3), 542-549.\u003c/li\u003e\n\u003cli\u003eKuemmerli, C., et al. (2024). Effect of enhanced recovery after surgery strategies on short-term outcomes in patients aged 70 years and older undergoing pancreaticoduodenectomy: A systematic review and individual patient data meta-analysis. \u003cem\u003eJournal of Hepato-Biliary-Pancreatic Sciences\u003c/em\u003e, 31(11), 892-901.\u003c/li\u003e\n\u003cli\u003eFeng, X., Zhang, C., Li, L., et al. (2025). Correlation between preoperative frailty and postoperative pulmonary complications in elderly cardiac surgery patients. \u003cem\u003eChinese Circulation Journal\u003c/em\u003e, 40(7), 689-693. (In Chinese)\u003c/li\u003e\n\u003cli\u003eChen, L., Wang, J., Liu, Y., et al. (2024). Prehabilitation in frail older adults scheduled for major abdominal surgery: A randomized controlled trial. \u003cem\u003eJournal of the American College of Surgeons\u003c/em\u003e, 238(3), e195-e204.\u003c/li\u003e\n\u003cli\u003eNational Institute for Health and Care Excellence (NICE). (2022). \u003cem\u003eEnhanced recovery after surgery: NICE guideline [NG193]\u003c/em\u003e. London: NICE.\u003c/li\u003e\n\u003cli\u003eZhao, Y., Sun, Y., \u0026amp; Zhou, J. (2025). Application effect and health economic evaluation of prehabilitation in patients undergoing major gastrointestinal cancer surgery. \u003cem\u003eChinese Journal of Gastrointestinal Surgery\u003c/em\u003e, 28(6), 543-549. (In Chinese)\u003c/li\u003e\n\u003cli\u003eEuropean Society for Clinical Nutrition and Metabolism (ESPEN). (2022). Guidelines on clinical nutrition in the elderly. \u003cem\u003eClinical Nutrition\u003c/em\u003e, 41(3), 528-554.\u003c/li\u003e\n\u003cli\u003eWang, Y., Li, X., Zhang, H., et al. (2023). Multidisciplinary enhanced recovery after surgery program improves outcomes in elderly patients with frailty undergoing abdominal surgery: A prospective cohort study. \u003cem\u003eAging Clinical and Experimental Research\u003c/em\u003e, 35(8), 2145-2153.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Enhanced Recovery After Surgery, Multidisciplinary intervention, Frailty, Elderly patients, Gastrectomy, Prognosis","lastPublishedDoi":"10.21203/rs.3.rs-8706174/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8706174/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e To explore the impact of a multidisciplinary intervention model guided by the Enhanced Recovery After Surgery (ERAS) concept on the prognosis of frail elderly patients undergoing gastrectomy and to provide clinical evidence for optimizing perioperative management strategies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A prospective cohort study design was adopted. A total of 186 frail elderly patients who underwent elective gastrectomy in our hospital from January 2023 to June 2025 were selected and divided into a control group (94 cases) and a conventional group (92 cases) based on the intervention method. The conventional group received the traditional perioperative management model, while the control group was subjected to a multidisciplinary collaborative ERAS intervention plan involving the surgical department, anesthesiology, nutrition, rehabilitation, geriatrics, and the nursing team. The postoperative complication rate, hospital stay, ICU stay, postoperative functional recovery, and 30-day readmission rate were compared between the two groups, and the clinical value of the multidisciplinary ERAS intervention was analyzed.\u003cbr\u003e\n \u003cstrong\u003eResults:\u003c/strong\u003e The total postoperative complication rate (χ² = 7.523, P = 0.006), postoperative hospital stay, and ICU stay of the control group were significantly shorter than those of the conventional group (P \u0026lt; 0.001). At 7 days postoperatively, the 6-minute walk test distance and the Mini-Mental State Examination scores of the control group were significantly better than those of the conventional group (all P \u0026lt; 0.001). The 30-day readmission rate of the control group was lower than that of the conventional group (χ² = 4.572, P = 0.032).\u003cbr\u003e\n \u003cstrong\u003eConclusion:\u003c/strong\u003e Implementing a multidisciplinary intervention based on the ERAS concept for frail elderly patients undergoing gastrectomy can significantly reduce the postoperative complication rate, shorten hospital stay, promote physical and cognitive function recovery, and improve clinical prognosis, which has important clinical promotion value.\u003c/p\u003e","manuscriptTitle":"The Impact of Multidisciplinary Intervention Under the Concept of ERAS on the Prognosis of Frail Elderly Patients Undergoing Gastrectomy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-19 08:46:31","doi":"10.21203/rs.3.rs-8706174/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-19T05:41:26+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-31T08:54:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"215937092074848747409468869910753151071","date":"2026-03-30T16:35:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"191227424015210052582343958246042046950","date":"2026-03-29T08:44:05+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-16T08:49:03+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-12T07:40:33+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-12T07:39:30+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2026-01-27T05:35:11+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0a21c3fd-3d0d-48bd-b176-5215acaee66a","owner":[],"postedDate":"March 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-19T08:46:31+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-19 08:46:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8706174","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8706174","identity":"rs-8706174","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}