The effect of perioperative multimodal rehabilitation on the frailty state of elderly patients with frailty gastrointestinal surgery:a randomized controlled trial

Background: Intervention programs for elderly patients with debilitating gastrointestinal tumors often involve three aspects: nutritional support, exercise and psychological care, but the intervention time is mostly focused on the preoperative period, and fewer studies have focused on the postoperative management of patients' debilitation. Therefore, this study proposes the hypothesis that nutritional support, exercise and psychological care should be combined to form a multimodal rehabilitation program applied to the perioperative debilitation management of patients in order to investigate the effects of perioperative multimodal rehabilitation on the debilitating state of elderly gastrointestinal surgery patients. Methods: This study was a double-arm, single-blind, parallel clinical randomized controlled trial. Elderly patients with debilitating gastrointestinal tumors admitted to Tongren Hospital, Shanghai Jiao Tong University, China from March to August 2024 were selected. They were randomized into an intervention group (IG) and a control group (CG). Subjects in the IG group received multimodal rehabilitation management during the perioperative period, and subjects in the CG group received conventional perioperative care. Changes in the patients' frailty status were assessed at admission, postoperative day 1, the day of discharge, and 1 week after discharge using the Fried frailty phenotype (FFP). Results: 102 people were finally included in this study, 51 in each of the IG and CG groups. There were 72 (70.58%) patients operated for intestinal cancer and 30 (29.42%) patients operated for gastric cancer; there were no between-group differences in the baseline characteristics of all variables ( P > 0.05), indicating adequate randomization. There was no between-group difference between the two groups for the primary outcome indicator Fried frailty phenotype score (FFP), but mixed-effects model analysis showed a significant between-group and time interaction effect ( P <0.001); the Fried frailty phenotype score (FFP) was significantly lower in the IG group than in the CG group at the time of discharge and at 1 week after discharge ( P <0.001). The IG group performed significantly better than the CG group on the 6-minute walk distance in secondary outcome indicators ( P =0.004<0.05). In addition, the IG group also had a significantly higher BI score than the control group ( P <0.001), and on the GDS-15 score, the IG group scored lower than the CG group ( P =0.011<0.05).The EQ-5D score of the IG group was significantly higher than that of the CG group ( P <0.001). There was no difference in the remaining secondary outcome indicators. Conclusion: Perioperative multimodal rehabilitation slows the progression of debilitation in elderly patients undergoing debilitating gastrointestinal surgery in order to facilitate their postoperative recovery. Clinical trial number : not applicable