Association of a Multimodal Perioperative Care Program With Postoperative Complications in Elderly Patients Undergoing Gastrectomy for Gastric Cancer

Abstract

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.