Geriatric Focused ERAS Nursing Practices in Open and Hybrid Aortic Vascular Surgery

Enhanced Recovery After Surgery (ERAS) pathways have been adapted for open and lower extremity vascular surgery and increasingly guide perioperative care for older adults. However, little is known about how perioperative nurses implement ERAS-consistent and geriatric-focused practices for older patients undergoing open and hybrid aortic procedures, particularly in hybrid operating room settings and in Chinese hospitals, where pathway maturity and geriatric integration may vary across centres.

To describe perioperative nurses' implementation of ERAS-consistent and geriatric-focused nursing practices for older adults undergoing open and hybrid aortic vascular surgery in China, and to identify nurse- and organisation-level factors associated with higher implementation, with attention to modifiable determinants (training, ERAS pathways, staffing).

Registered nurses working in operating theatres/hybrid operating rooms, post-anaesthesia care units, intensive care/high-dependency units, vascular surgical wards and pre-assessment clinics in eight tertiary general hospitals in Shanxi Province, China, were surveyed between March and July 2024. The Geriatric-Focused Vascular ERAS Nursing Practices Questionnaire, developed from ERAS/SVS guidelines and geriatric surgery literature, measured nurse-reported implementation across perioperative domains, geriatric-focused elements, attitudes and perceived barriers. The instrument underwent expert review, pilot testing and internal consistency assessment, while more advanced psychometric testing was beyond the scope of this initial multicentre study. Data were analysed using descriptive statistics, group comparisons and multivariable linear regression; free-text responses were examined using inductive qualitative content analysis. The study was conceptually informed by a Donabedian structure-process-outcome framework and a capability-opportunity-motivation perspective on behaviour change.

Of 640 eligible nurses, 428 provided analysable responses (usable response rate 66.9%). The global ERAS implementation score (1-5) was 3.41 (SD 0.49). Implementation was highest for intraoperative/post-anaesthesia practices (3.82, SD 0.61) and preoperative education/optimisation (3.63, SD 0.72), and lowest for frailty and cognitive/delirium assessment (2.71, SD 0.81). Routine frailty assessment was reported by 23.4% and routine use of structured delirium screening tools by 30.8%. Higher implementation was independently associated with ERAS-specific training (B = 0.28, p < 0.001), geriatric/frailty training (B = 0.12, p = 0.008), working in hospitals with a formal ERAS pathway (B = 0.24, p < 0.001), higher perceived staffing adequacy (B = 0.09, p = 0.004), and greater experience (B = 0.04 per 5 years, p = 0.012) (adjusted R² = 0.38). Qualitative findings highlighted ERAS as an "ideal rather than daily reality", challenges in technology-dense environments, fragmented responsibilities, and the need for leadership and tailored education.

Perioperative nurses in these tertiary hospitals reported moderate implementation of ERAS-consistent care for older adults undergoing open and hybrid aortic vascular surgery, with substantial gaps in frailty assessment, delirium screening and geriatric-tailored practices. These gaps are clinically important because they may limit timely risk recognition and tailoring of perioperative care in a high-risk older surgical population. ERAS-specific and geriatric training, hospital-level ERAS pathways, perceived staffing adequacy and experience were associated with higher implementation and represent important modifiable targets, although causal relationships cannot be inferred from this cross-sectional survey.