Chinese Journal of Clinical Nutrition · Oct 30, 2026
Effect of perioperative multidimensional rehabilitation on clinical outcomes in elderly abdominal surgical patients with malnutrition, frailty, and/or sarcopenia
By 李永浩, 栾潇溢, 李祎琳 et al.
Objective To investigate the differential effects of perioperative multidimensional rehabilitation techniques on clinical outcomes in older adult patients undergoing abdominal surgery across different geriatric syndrome subgroups (malnutrition, frailty, and sarcopenia).Methods This study was a secondary analysis of a randomized controlled trial, in which 120 older adult patients aged ≥65 years undergoing grade 3–4 abdominal surgery were randomly divided into an intervention group ( = 60) and a control group ( = 60). The multidimensional rehabilitation intervention was implemented by a multidisciplinary team in three phases (preoperative, postoperative, and 30 days after discharge), including graded nutritional management based on the Nutritional Risk Screening 2002 (NRS 2002) score (with oral nutritional supplements as the main approach, supplemented by enteral or parenteral nutrition when necessary), structured aerobic and resistance exercise prescriptions, and standardized psychological counseling. The intervention was reinforced through telephone/WeChat follow-ups to enhance compliance outside the hospital. The control group received conventional perioperative management and general dietary and exercise guidance. On this basis, patients were identified as having malnutrition, frailty, and/or sarcopenia according to the Global Leadership Initiative on Malnutrition (GLIM) criteria, the Fried frailty score, and the Asian Working Group for Sarcopenia 2019 (AWGS 2019) criteria, respectively. The differences in clinical characteristics and clinical outcomes between the groups were analyzed. Results Of the 120 patients, 51 (42.5%) had malnutrition, 84 (70%) had frail, and 20 (16.7%) had sarcopenia. In the malnutrition subgroup, the intervention group showed significantly greater absolute weight change than the control group ( = 0.043), whereas no significant differences were observed in readmission rate, complication rate, length of hospital stay, or hospitalization costs (all >0.05). In the frailty subgroup, the intervention group had a significantly lower complication rate ( = 0.020), shorter postoperative hospital stay ( = 0.027), and lower hospitalization costs ( =0.010) compared to the control group. In the sarcopenia subgroup, no significant differences were found between the intervention and control groups in absolute changes of weight, upper arm circumference, calf circumference, or grip strength (all >0.05). Conclusion Perioperative multidimensional rehabilitation techniques have differential effects on clinical outcomes among older adult patients undergoing abdominal surgery across different geriatric syndrome subgroups (malnutrition, frailty, and sarcopenia). Future efforts should focus on developing and optimizing individualized combinations of nutritional and exercise prescriptions based on different geriatric syndromes to achieve more precise perioperative rehabilitation management.