Annals of gastroenterological surgery · 2026
Association of a Multimodal Perioperative Care Program With Postoperative Complications in Elderly Patients Undergoing Gastrectomy for Gastric Cancer.
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Fujiya Keiichi, Fuseya Hiroshi, Yonenaga Yusuke, Sanada Keiko, Inano Toshimi, Oguma Yumi, Nakajima Kazuko, Ando Chikako, Oka Kumiko, Koseki Yusuke, Furukawa Kenichiro, Tanizawa Yutaka, Terashima Masanori, Bando Etsuro
Аннотация
PURPOSE: This retrospective study aimed to assess the clinical effectiveness of a multimodal perioperative care program in reducing postoperative complications in elderly patients undergoing gastrectomy for gastric cancer.
METHODS: Overall, 1285 patients aged ≥ 75 years who underwent curative gastrectomy were classified into pre-program (2008-2018, n = 965) and post-program (2020-2024, n = 320) groups. The program consisted of preoperative nutritional counseling, oral care, swallowing and physical function screening, and targeted rehabilitation. The clinical characteristics and surgical outcomes of the two groups were compared.
RESULTS: In the post-program group, 314 patients underwent swallowing screening, with 108 receiving targeted speech-language therapy and 49 being prescribed a dysphagia diet. Physical function screening was conducted on 281 patients, with 204 receiving perioperative exercise therapy. Program implementation was significantly associated with a lower incidence of overall complications (21% vs. 40%), surgical (13% vs. 21%) and non-surgical complications (7% vs. 17%), pneumonia (4% vs. 9%), and delirium (3% vs. 7%). Multivariate analysis revealed that the program was independently associated with a significantly decreased incidence of overall complications (odds ratio [OR]: 0.431, p < 0.001) and non-surgical complications (OR: 0.309, p < 0.001). Meanwhile, the reduction in the incidence of surgical complications was not statistically significant (OR: 0.696, p = 0.094).
CONCLUSIONS: Multimodal perioperative care program may effectively reduce postoperative complications, particularly non-surgical complications such as pneumonia, in elderly patients with gastric cancer.
METHODS: Overall, 1285 patients aged ≥ 75 years who underwent curative gastrectomy were classified into pre-program (2008-2018, n = 965) and post-program (2020-2024, n = 320) groups. The program consisted of preoperative nutritional counseling, oral care, swallowing and physical function screening, and targeted rehabilitation. The clinical characteristics and surgical outcomes of the two groups were compared.
RESULTS: In the post-program group, 314 patients underwent swallowing screening, with 108 receiving targeted speech-language therapy and 49 being prescribed a dysphagia diet. Physical function screening was conducted on 281 patients, with 204 receiving perioperative exercise therapy. Program implementation was significantly associated with a lower incidence of overall complications (21% vs. 40%), surgical (13% vs. 21%) and non-surgical complications (7% vs. 17%), pneumonia (4% vs. 9%), and delirium (3% vs. 7%). Multivariate analysis revealed that the program was independently associated with a significantly decreased incidence of overall complications (odds ratio [OR]: 0.431, p < 0.001) and non-surgical complications (OR: 0.309, p < 0.001). Meanwhile, the reduction in the incidence of surgical complications was not statistically significant (OR: 0.696, p = 0.094).
CONCLUSIONS: Multimodal perioperative care program may effectively reduce postoperative complications, particularly non-surgical complications such as pneumonia, in elderly patients with gastric cancer.