The Application Of ERAS Mediated By MDT In Perioperative Nursing Of Frail Elderly Patients With Prostate Cancer

Objectives The aim of this study is to explore the impact of the Enhanced recovery after surgery(ERAS)Model mediated by the Multidisciplinary Team(MDT)on elderly patients with prostate adenocarcinoma undergoing elective extraperitoneal laparoscopic radical prostatectomy,and evaluate the effect of perioperative nursing under its application,so as to improve the prognosis of elderly patients with prostate cancer and promote rapid recovery.Methods According to the inclusion and exclusion criteria,a total of 72 frail elderly patients diagnosed with prostate adenocarcinoma who were hospitalized in the Department of Urology of a Class III Grade A hospital from December 2021 to October 2022 were selected by the convenient sampling method.The perioperative nursing plan was ERAS concept mediated by MDT.The even number was entered into the routine group,and the perioperative nursing plan was routine perioperative nursing.The surgeries of both groups were performed by the same medical team.The general information,frailty scores before and after discharge,time to first anal ventilation after surgery,time to first ambulation after surgery(calculated from the end of surgery),average length of hospital stay after surgery,unplanned readmission rate within 3 months after surgery,and hospitalization expenses of the patients were collected.All data were analyzed by SPSS23.0 software.The Edmonton frail scale(EFS)score before and after discharge,time to first anal ventilation after surgery,time to first ambulation after surgery(calculated from the end of surgery),average length of hospital stay,unplanned readmission rate within 3months after surgery,and hospitalization costs were compared between the two groups.Results1.Baseline survey resultsThe two groups were well balanced and comparable in age,marital status,education level,living condition,family monthly income,smoking status,drinking status,care status,exercise status,occupation,and payment method(P>0.05);There were no significant differences in Body Mass Index(BMI),Gleason score,prostate specific antigen(PSA)level,and clinical stage between the two groups(P>0.05);There was no significant difference in EFS frailty score between the two groups before operation,which was comparable(P>0.05).2.Study results(1)The EFS frailty score of the two groups before discharge was 8.17±1.75 in the MDT group and 7.39±1.44 in the conventional group.The EFS frailty score of the MDT group before discharge was significantly lower than that of the conventional group(P<0.05).(2)The average time to first flatus was 20.9±3.96 hours in the MDT group and 34.9±3.66 hours in the conventional group.The time to first flatus in the MDT group was significantly earlier than that in the conventional group(P<0.05).(3)The average length of hospital stay was 11.58±3.29 days in the MDT group and15.47±3.46 days in the conventional group.The MDT group was discharged earlier than the conventional group,and the difference was statistically significant(P<0.05).(4)The average hospitalization expenses of the two groups were respectively 27.2 ± 10.6thousand yuan in the MDT group and 33.2 ± 9.2 thousand yuan in the conventional group.The average hospitalization expenses of the MDT group were lower than those of the conventional group,and the difference was statistically significant(P<0.05).Conclusions(1)In this study,the use of EFS can identify elderly patients with frailty before radical prostatectomy.The integration of MDT-mediated ERAS model into nursing interventions can significantly improve the frailty condition of patients,accelerate the first postoperative anal exhaust time and ambulation time,and reduce the length of hospital stay,which can provide an empirical basis for clinical better perioperative nursing intervention for elderly prostate cancer patients with the risk of preoperative frailty.(2)The preoperative frailty risk assessment for elderly patients with prostate cancer undergoing radical prostatectomy can help formulate personalized perioperative nursing measures and promote postoperative rehabilitation of patients,which is in line with the concept of evidence-based nursing and enhanced recovery after surgery,and has certain scientificality and feasibility.It can provide reference for clinical routine of perioperative management of elderly patients with frailty undergoing radical prostatectomy.