INTRODUCTION
This article reviews the evidence-based advances and practical innovations of this model in the areas of rational medication use, traditional Chinese medicine (TCM)-specific interventions, and comprehensive convalescent care following gastrointestinal surgery in elderly patients, providing theoretical support and clinical guidance for establishing a multidisciplinary integrated diagnosis and treatment system[1]. A literature search was conducted in the PubMed, Web of Science, and CNKI databases for studies published from database inception to 2025[2]. The search terms included combinations of “elderly patients”, “gastrointestinal surgery”, “enhanced recovery after surgery (ERAS)”, “traditional Chinese medicine”, “rehabilitation”, “rational medication”, and “comprehensive care”[3]. Studies were included if they investigated perioperative management, medication strategies, TCM interventions, rehabilitation approaches, or integrated management models for elderly patients undergoing gastrointestinal surgery[4]. Systematic reviews, meta-analyses, randomized controlled trials, prospective studies, clinical guidelines, and relevant observational studies were considered eligible[5]. Studies unrelated to gastrointestinal surgery, nonhuman studies, and articles lacking sufficient clinical relevance were excluded[6]. The quality and strength of the evidence were evaluated according to study design and methodological rigor. Evidence from systematic reviews, meta-analyses, and randomized controlled trials was considered higher-level evidence, whereas observational and exploratory technology-based studies [e.g., artificial intelligence (AI)-assisted pattern differentiation] were interpreted cautiously because of their potential limitations in generalizability and clinical validation.
PATHOPHYSIOLOGICAL CHARACTERISTICS OF POSTOPERATIVE GERIATRIC PATIENTS AND CORE PRINCIPLES OF MEDICATION NURSING
The pathophysiological characteristics of elderly patients following gastrointestinal surgery are distinctive and form the basis for developing individualized medication and care plans. The combined effects of surgical trauma, anesthesia, and the inflammatory response can readily induce gastrointestinal motility disorders, manifested by abdominal distension and delayed bowel function; in severe cases, these disorders may progress to postoperative ileus[7]. A reduced pain threshold makes postoperative pain more likely to trigger sympathetic activation and stress responses, which may interact with sleep disturbances and circadian rhythm disruption, thereby increasing the risk of poor postoperative recovery and delirium[8]. Impaired immune function combined with prolonged bed rest increases the risk of pulmonary and surgical site infections[9]. Inadequate perioperative nutritional intake, stress-induced hypermetabolism, and impaired nutrient absorption frequently interact to cause nutritional disorders such as hypoproteinemia and anemia[10]. Age-related deterioration of hepatic and renal function reduces the capacity for drug metabolism and excretion, thereby increasing the risk of drug accumulation, adverse drug reactions, and postoperative delirium[11]. Recent studies have shown that postoperative gut microbiota dysbiosis, characterized by reduced levels of Bifidobacterium and Lactobacillus and increased levels of Enterococcus, is closely associated with delayed gastrointestinal recovery and an increased risk of infection, providing a theoretical basis for targeted interventions[6].
Definition and framework of surgery-TCM-convalescence model
The postoperative physiological changes in elderly patients undergoing gastrointestinal surgery can be categorized into five clinically relevant domains. First, gastrointestinal dysfunction is one of the most common postoperative complications. Surgical stress, anesthesia, inflammatory responses, and age-related reductions in intestinal motility may contribute to delayed gastrointestinal recovery, abdominal distension, nausea, and postoperative ileus. In addition, postoperative disruption of the gut microbiota, characterized by reduced levels of beneficial bacteria such as Bifidobacterium and Lactobacillus and increased levels of opportunistic pathogens, may further impair intestinal barrier function and delay recovery. Second, immune dysfunction and increased susceptibility to infection represent major postoperative challenges. Age-related immunosenescence, combined with surgical stress and prolonged immobilization, may impair immune defenses and increase the risk of pulmonary infections, surgical site infections, and systemic inflammatory responses. Third, nutritional vulnerability and impaired metabolic recovery are frequently observed in elderly patients. Reduced appetite, inadequate perioperative nutritional intake, stress-induced hypermetabolism, and impaired nutrient utilization may contribute to hypoalbuminemia, anemia, and loss of skeletal muscle mass, thereby delaying wound healing and functional recovery. Fourth, altered pharmacokinetics and increased medication-related risks require particular attention. Age-related declines in hepatic and renal function may reduce drug metabolism and clearance, thereby increasing the risk of drug accumulation, adverse drug reactions, and drug-drug interactions. This risk is further amplified in elderly patients receiving polypharmacy. Fifth, neurocognitive vulnerability should not be overlooked. Postoperative pain, sleep disturbances, inflammatory responses, and increased sensitivity to medications may increase the risk of delirium and cognitive dysfunction, which are closely associated with prolonged hospitalization and poor rehabilitation outcomes.
Based on the above characteristics, rational medication and nursing care for elderly patients following gastrointestinal surgery should adhere to the following principles: First, individualized medication, with comprehensive consideration of age, physiological reserve, comorbidities, and hepatic and renal function to optimize the selection and dosage of medications; second, the use of low doses and short treatment courses, while avoiding unnecessary polypharmacy to reduce the risk of drug accumulation; third, a multimodal approach integrating pharmacological and nonpharmacological interventions to synergistically promote gastrointestinal recovery and alleviate physiological stress; fourth, continuous dynamic monitoring, including systematic assessment of pain, gastrointestinal motility, signs of infection, nutritional status, and adverse drug reactions, with timely optimization of the treatment plan; and fifth, continuity of care by strengthening post-discharge follow-up and health management and establishing an integrated inpatient-to-outpatient rehabilitation pathway to ensure the quality and safety of recovery[12].
RATIONAL MEDICATION STRATEGIES AND KEY PRACTICE POINTS FOR GERIATRIC PATIENTS AFTER GASTROINTESTINAL SURGERY
Pharmacological management for elderly patients undergoing gastrointestinal surgery should adhere to the principles of safety, efficacy, and precision, with individualized treatment plans developed for pain management, restoration of gastrointestinal motility, antimicrobial therapy, nutritional intervention, and prevention of complications. Pain management strategies should be based on multimodal analgesia, emphasizing the preferential use of nonopioid analgesics, supplemented by regional nerve blocks, while strictly limiting opioid use[13]. For baseline analgesia, selective cyclooxygenase-2 inhibitors, such as parecoxib and celecoxib, are recommended because they provide significant opioid-sparing effects and help reduce the risk of opioid-related adverse drug reactions[14]. Regional anesthetic techniques, such as ultrasound-guided transversus abdominis plane blocks, provide effective analgesia while having minimal impact on bowel function[15]. Opioids should be reserved for rescue analgesia, with short-acting formulations administered at carefully titrated low doses[13-15].
Gastrointestinal function management focuses on promoting intestinal motility and reducing the incidence of postoperative ileus. Recent systematic reviews and network meta-analyses have comprehensively compared various strategies for the prevention and management of postoperative ileus, including chewing gum, epidural analgesia, and peripherally acting opioid antagonists, thereby providing an evidence base for an integrated perioperative approach based on reduced opioid use, early mobilization, and promotion of bowel function recovery[16]. The selection and dose adjustment of prokinetic agents require individualized assessment, monitoring, and risk management while considering the patient’s electrocardiographic findings (e.g., QT interval), hepatic and renal function, and potential drug-drug interactions[17].
Infection prevention should adhere to the principle of “targeted medication and prevention-oriented care”. Key aspects, including the timing of perioperative prophylactic antibiotic administration, intraoperative redosing, and early discontinuation of antibiotic therapy, should be guided by evidence-based guidelines and implemented according to the type of surgery and the patient’s risk stratification. The treatment of postoperative infections requires antibiotic selection based on bacterial culture and antimicrobial susceptibility test results, with dosage adjustments according to the patient’s hepatic and renal function[18]. Nutritional support should follow the principles of “early enteral nutrition, targeted support, and dynamic assessment”, with nutritional therapy advanced gradually according to the patient’s tolerance. Perioperative nutritional status and functional recovery should be continuously monitored and managed within the ERAS program using indicators such as body weight, muscle mass, nutritional intake, and inflammatory and metabolic markers[16].
TCM CHARACTERISTIC INTERVENTION PATHWAY UNDER THE SURGERY-TCM-CONVALESCENCE MODEL
The surgery-TCM-convalescence integrated model is a comprehensive management framework for elderly patients following gastrointestinal surgery. Its core lies in the integration of three complementary dimensions. The surgical dimension focuses on precision surgery and optimization of ERAS protocols to minimize surgical trauma and perioperative stress. The TCM dimension is based on pattern differentiation and treatment, regulating the body’s overall balance through internal and external therapies. The convalescence dimension extends beyond the short-term scope of traditional ERAS postoperative care by establishing a continuum of care from the hospital to the community and home, thereby promoting long-term functional recovery and improving quality of life[2,10]. Compared with traditional ERAS, this model not only extends the temporal scope of care from the perioperative period to long-term rehabilitation but also broadens the scope of intervention by incorporating the holistic perspective of TCM, continuity of care, and the concept of whole-person rehabilitation, thereby forming a closed-loop cycle of “acute-phase treatment-subacute-phase intervention-chronic-phase rehabilitation-long-term health management”[3,12].
Based on the principles of pattern differentiation and treatment and characterized by its gentle and noninvasive nature, TCM interventions have become an integral component of postoperative gastrointestinal rehabilitation in elderly patients, with current research focusing on the standardization of pattern differentiation, precision of interventions, and integration with modern technologies. According to TCM theory, the core pathomechanisms in elderly patients following gastrointestinal surgery include spleen-stomach deficiency, qi and blood deficiency, qi stagnation and blood stasis, and obstruction of zang-fu qi. The corresponding therapeutic principles include strengthening the spleen and harmonizing the stomach, tonifying qi and nourishing blood, regulating qi and unblocking the zang-fu, and reinforcing the body’s defenses while consolidating the root, using a comprehensive approach that combines internal and external therapies[19]. Recently, AI-assisted pattern differentiation technology has shown theoretical advances by utilizing data on tongue coating, pulse characteristics, and clinical symptoms in combination with big data algorithms to identify TCM patterns. Chen et al[20] reported that a deep learning-based TCM diagnostic prediction model achieved a pattern classification accuracy of 92.6%, providing a potential technical pathway toward the objectification of TCM pattern differentiation. However, this technology remains at the laboratory validation stage and has not yet been demonstrated in clinical practice to effectively guide individualized interventions or improve patient outcomes. The transition from accurate pattern identification to effective treatment still requires overcoming several challenges, including clinical implementation, optimization of treatment protocols, and improvement of clinical outcomes. Therefore, further research is warranted. Although AI-assisted pattern differentiation models have demonstrated promising diagnostic performance, the clinical significance of improved pattern recognition accuracy remains uncertain. High classification accuracy indicates the potential of AI technology to enhance the objectivity and consistency of TCM diagnosis. However, whether accurate pattern identification can directly translate into improved clinical outcomes, such as faster gastrointestinal functional recovery, fewer postoperative complications, shorter hospital stay, or improved quality of life, has not been adequately established. Current evidence primarily focuses on algorithm development and diagnostic validation, whereas prospective clinical studies evaluating whether AI-guided individualized TCM interventions improve patient-centered outcomes remain lacking. Future research should therefore integrate AI-based pattern recognition into clinical decision-making pathways and evaluate its real-world effectiveness through multicenter controlled trials.
Internal treatment in TCM is centered on pattern differentiation and the prescription of herbal formulas. Simotang and Xiangsha Liujunzi Tang strengthen the spleen, regulate qi, harmonize the stomach, and promote gastrointestinal motility, thereby facilitating the recovery of bowel function after surgery. Buzhong Yiqi Tang and Huangqi Jianzhong Tang primarily tonify qi and reinforce the body’s defenses, thereby enhancing immune function. Banxia Xiexin Tang harmonizes cold and heat, directs rebellious qi downward, and relieves vomiting, thereby alleviating postoperative gastrointestinal symptoms such as nausea and vomiting[21,22]. Recent research has further elucidated the mechanisms of action of the active components in these classical formulas and has led to the development of novel dosage forms, such as granules and oral liquids, thereby improving medication adherence among elderly patients[23]. Building on advances in probiotic research, investigators have proposed a preliminary strategy combining food-medicine homologous ingredients with probiotics. This strategy tailors dietary interventions according to the postoperative stage and TCM pattern, aiming to achieve synergistic effects through nutritional support, TCM regulation, and modulation of the intestinal microbiota. However, its clinical efficacy and underlying mechanisms require further validation through high-quality clinical studies[24,25].
External TCM therapies demonstrate significant advantages in elderly postoperative patients, with recent innovations focusing on the standardization of treatment protocols, intelligent devices, and objective efficacy assessment. Acupoint plaster application adopts a “pattern differentiation-based prescription plus ultrasound-guided precise acupoint localization” approach. By optimizing the herbal formulation and applying medicinal plasters to acupoints such as Zhongwan, Shenque, and Zusanli, this therapy may regulate gastrointestinal hormone secretion and improve the composition of the gut microbiota[26]. Electroacupuncture combined with warm moxibustion utilizes intelligent electroacupuncture devices to precisely control stimulation parameters, thereby enhancing therapeutic efficacy in patients with postoperative gastroparesis[27]. Moxibustion and umbilical therapy are considered suitable for elderly patients with a deficient-cold constitution according to TCM theory[28]. Auricular acupressure with seeds and abdominal massage may alleviate postoperative abdominal distension and insomnia while helping to prevent intestinal adhesions and constipation[29]. Furthermore, as adjunctive interventions, emotional therapies such as Five Elements music therapy and meditation, combined with exploratory qigong practices such as the Eight Brocades and abdominal breathing exercises, may improve mood, enhance physical function, and promote integrated mind-body rehabilitation[30].
DEVELOPMENT AND IMPLEMENTATION OF A COMPREHENSIVE POSTOPERATIVE NURSING SYSTEM FOR
Convalescent care represents an extension of the integrated surgery-TCM-convalescence model. Compared with traditional ERAS postoperative care, its management objectives extend beyond standardized perioperative and early postoperative management to encompass long-term rehabilitation and improvement of functional outcomes[2,10]. Convalescent care emphasizes long-term, individualized, and multidimensional rehabilitation support, with management continuing for several months after discharge. It strengthens continuity of care beyond the hospital through strategies such as remote monitoring. Its core lies in integrating Western medicine-based risk assessment and functional evaluation with holistic TCM rehabilitation and modern intelligent technologies to promote functional recovery, prevent complications, improve gastrointestinal function, and facilitate psychological adaptation[19,27,29]. In clinical practice, the surgical team is responsible for acute-phase management and development of the early rehabilitation plan; the TCM team provides pattern differentiation-based interventions and gastrointestinal function regulation strategies; and the convalescence care team is responsible for implementing, monitoring, and dynamically adjusting long-term rehabilitation plans after discharge[13,15,18].
In recent years, continuous remote monitoring, using wearable devices to continuously collect vital signs, symptoms, and activity data, combined with home follow-up has been used to support safe monitoring and timely intervention for patients undergoing colorectal surgery after early discharge, achieving high patient satisfaction and partially addressing the challenges of data gaps and delayed intervention in the outpatient setting[31]. Studies further indicate that incorporating wearable devices into continuous remote early warning systems is feasible and safe for postoperative monitoring. The integration of AI and wearable technology holds promise for enhancing perioperative risk identification and individualized management but requires further multicenter validation and protocol standardization[32]. ERAS spans the entire course of in-hospital rehabilitation and emphasizes key elements such as early mobilization, early resumption of oral intake with stepwise dietary advancement, minimization of unnecessary catheterization, and optimization of perioperative management. These principles have been incorporated into the ERAS guidelines for colorectal surgery[33]. Nutritional care follows the “assessment-precision support-microbiome synergy” framework, implementing individualized nutritional support based on nutritional risk assessment[34]. Psychological and sleep management focuses on anxiety, depression, and sleep disorders. Systematic reviews suggest that technology-assisted music interventions can reduce perioperative anxiety and alleviate pain and may be incorporated into nonpharmacological intervention pathways[35]. Complication prevention and rehabilitation training adopt multidimensional strategies, including respiratory training, pharmacological and mechanical prophylaxis for deep vein thrombosis, and pelvic floor muscle training, together with the development of individualized rehabilitation plans. Post-discharge follow-up relies on a closed-loop system of “smart monitoring-remote guidance-multidisciplinary collaboration”, providing continuous guidance on risk alerts, medication management, nutritional support, and rehabilitation to improve long-term recovery outcomes[36].
CLINICAL APPLICATION OUTCOMES OF THE INTEGRATED SURGERY-TCM-CONVALESCENCE MODEL
The surgery-TCM-convalescence integrated model, underpinned by evidence-based practice and innovative management concepts, has the potential to improve perioperative outcomes and enhance the quality of postoperative rehabilitation through a holistic approach. Regarding gastrointestinal functional recovery, a multistrategy approach centered on ERAS pathways, combined with TCM, acupuncture, and microbiota-targeted nutritional support, may promote the recovery of gastrointestinal motility (e.g., earlier return of bowel sounds and earlier passage of flatus and stool) and alleviate symptoms of gastrointestinal intolerance. However, because of differences in intervention combinations, implementation intensity, and baseline patient characteristics, considerable heterogeneity exists in the reported outcomes, and further high-quality studies are required to determine the optimal treatment strategy[37]. Regarding the prevention and management of postoperative complications, multidisciplinary collaboration and standardized ERAS protocols can reduce the overall incidence of complications and shorten the length of hospital stay. In addition, perioperative probiotic and prebiotic interventions have been associated with a reduced risk of postoperative infections in patients undergoing colorectal cancer surgery and may serve as adjunctive therapeutic strategies[38]. Regarding nutritional status and immune recovery, risk-stratified, individualized nutritional support combined with modulation of the gut microbiota may improve nutritional indicators and promote immune recovery. However, the optimal selection of probiotic strains, timing of initiation, dosage, and the potential benefits of combination therapy require further validation[39]. Regarding quality of life, multidimensional nursing care combined with continuity of care helps improve pain, sleep quality, mood, and functional recovery, particularly in frail elderly patients. Nevertheless, standardized implementation pathways and standardized outcome assessment methods remain necessary to improve interstudy comparability and facilitate clinical translation[40] (Figure 1).
Figure 1
Schematic diagram of integrated rehabilitation management mode of traditional Chinese and Western medicine for elderly patients after gastrointestinal surgery.
CURRENT ISSUES AND FUTURE ACTIONABLE STRATEGIES
The clinical application of this model still faces several limitations. First, the multidisciplinary collaboration mechanism remains underdeveloped. There is a lack of unified diagnostic and treatment pathways across disciplines such as surgery, TCM, nursing, rehabilitation, and nutrition, and communication and coordination remain inadequate. Consequently, the synergistic potential of AI-assisted pattern differentiation and intelligent healthcare modules has not been fully realized. Second, the standardization of TCM interventions remains insufficient. Significant variations exist among institutions in pattern differentiation, acupoint selection protocols, medication dosages, and treatment duration. Furthermore, existing evidence is derived predominantly from small-sample, single-center studies, with relatively few high-quality randomized controlled trials. In addition, the mechanisms underlying the synergistic effects of TCM and other technologies remain unclear. Third, the continuity-of-care system after hospital discharge remains underdeveloped. The adoption of intelligent healthcare technologies remains limited, and community-based rehabilitation and home care services lack adequate infrastructure and support, making it difficult to ensure the sustained and standardized delivery of post-discharge medication guidance, rehabilitation training, and nutritional management. Fourth, there is a lack of dedicated research involving specific patient populations, including elderly patients, frail individuals, and patients receiving polypharmacy. Consequently, individualized treatment strategies remain insufficient, and the high cost of innovative technologies limits their widespread implementation in primary healthcare settings.
In response to the above issues, the following priorities should be addressed in future research and clinical practice: First, establish integrated multidisciplinary diagnostic, treatment, and nursing pathways; clearly define the roles, responsibilities, and collaborative workflows of each discipline; develop standardized protocols; and strengthen multidisciplinary coordination mechanisms for AI-assisted pattern differentiation and intelligent healthcare technologies. Second, conduct large-scale, multicenter randomized controlled trials to standardize criteria for TCM pattern differentiation, acupoint selection, and efficacy evaluation; elucidate the synergistic mechanisms of TCM external therapies, microbiota-targeted nutritional interventions, and intelligent healthcare technologies; and strengthen the evidence base supporting these interventions. Third, optimize digital rehabilitation management platforms, promote validated intelligent healthcare models, reduce the implementation costs of intelligent devices and AI platforms, and refine the three-tier continuity-of-care system spanning hospital, community, and home settings. Fourth, conduct stratified research involving specific elderly patient populations and develop stage-specific, individualized treatment strategies based on physiological characteristics, gut microbiota profiles, and TCM pattern differentiation. Finally, strengthen health education and caregiver training to establish a collaborative rehabilitation management model involving healthcare providers, patients, and caregivers; promote the translation and implementation of innovative technologies; develop scalable solutions for primary healthcare settings; and improve the quality of diagnosis, treatment, and nursing services at the primary care level.
CONCLUSION
The surgery-TCM-convalescence integrated model represents a paradigm shift in the postoperative management of elderly patients undergoing gastrointestinal surgery, moving from a single-discipline approach to multidisciplinary integration, from short-term intervention to comprehensive continuum-of-care management, and from disease-centered treatment to functional rehabilitation. Through the synergistic integration of three core components - precision surgery, holistic regulation through TCM, and sustained convalescent support - this model addresses the challenges associated with postoperative physiological vulnerability, the high incidence of complications, and prolonged rehabilitation in elderly patients. In clinical practice, the potential value of this model has begun to emerge. During the acute phase, multimodal analgesia and gastrointestinal function-promoting strategies may reduce the risk of complications. During the subacute phase, pattern differentiation-based treatment combined with modulation of the gut microbiota may accelerate functional recovery. During the long-term rehabilitation phase, intelligent monitoring and individualized convalescence programs may improve quality of life. However, the standardized implementation of this model continues to face challenges, including underdeveloped multidisciplinary collaboration mechanisms, inconsistent standards for TCM interventions, and inadequate continuity-of-care systems after hospital discharge. Future development should focus on establishing unified clinical pathways, deepening mechanistic research, optimizing the implementation of intelligent technologies, and developing scalable models for primary healthcare settings, ultimately achieving precision, individualization, and continuity in the postoperative management of elderly patients undergoing gastrointestinal surgery.
Peer review: Externally peer reviewed.
Peer-review model: Single blind
Specialty type: Gastroenterology & Hepatology
Country of origin: China
Peer-review report’s classification
Scientific quality: Grade B, Grade C
Novelty: Grade B, Grade C
Creativity or innovation: Grade B, Grade C
Scientific significance: Grade B, Grade C
P-Reviewer: Hoshino I, MD, Japan; Jeon SW, MD, South Korea S-Editor: Wang JJ L-Editor: A P-Editor: Zhao YQ
