ObjectiveTo explore the application effect of an exercise nudge program based on the theory of planned behavior in patients undergoing adjuvant chemotherapy after colorectal cancer surgery.MethodsA total of 56 colorectal cancer patients undergoing postoperative adjuvant chemotherapy in a tertiary grade A hospital in Shanghai were selected as the study subjects.They were randomly divided into an intervention group and a control group,with 28 cases in each group.The control group received routine follow⁃up and guidance from a health education booklet.The intervention group received an exercise nudge program based on the theory of planned behavior.The intervention lasted for 12 weeks.Exercise adherence,exercise self⁃efficacy,6⁃minute walk test,and grip strength were evaluated in both groups.The incidence of adverse events during exercise was also compared between the two groups.ResultsThe interaction effects between time and group on overall exercise adherence and adherence in various dimensions were statistically significant(P<0.05).The time effect, group effect, and interaction effect on exercise self-efficacy scores were statistically significant(P<0.001).The time effect and interaction effect on the 6⁃minute walk test and grip strength were statistically significant(P<0.001).The incidence of muscle soreness and cardiac discomfort in the intervention group was lower than that in the control group(P<0.05).ConclusionsThe exercise intervention combining nudge strategy and the theory of planned behavior is safe and feasible.It helps improve exercise self⁃efficacy and exercise adherence in colorectal cancer chemotherapy patients and enhances their physical function.

Body composition is increasingly recognised as an important determinant of surgical outcomes, yet the relative contributions of its distinct physiological domains, particularly metabolic burden and structural or functional reserve, remain unclear. We aimed to comparatively evaluate the independent associations of visceral adiposity and muscle-related parameters with postoperative complications after gastrectomy within a unified analytical framework. In this retrospective cohort study, we analysed 362 patients undergoing curative gastrectomy for gastric cancer. Preoperative body composition was assessed using CT-derived skeletal muscle index, muscle density, and visceral fat area, together with functional measures including grip strength and walking speed. Associations with short-term and 30-day postoperative complications were examined using hierarchical multivariable logistic regression models. Dose–response relationships were evaluated using restricted cubic splines, and supplementary sensitivity and internal validation analyses were performed. Across all adjusted models, visceral adiposity showed a consistent and independent association with postoperative complications. Each one-standard deviation increase in visceral fat area was associated with higher odds of short-term complications (OR 1.55, 95

Background:Sleep disorders and cognitive impairment commonly co-occur after acute ischemic stroke (AIS), yet their co-development is rarely modeled jointly. Objective:To determine whether sleep quality and cognitive function after AIS show asynchronous rather than automatically parallel recovery trajectories during the first year after discharge, and to identify distinct joint trajectory subgroups and baseline factors associated with trajectory membership. Methods:In this single-center prospective cohort in Shanghai (December 2023-October 2024), AIS inpatients were assessed within 24 h before discharge (T1) and at 3 (T2) and 12 months (T3). Sleep quality (PSQI; reverse-coded for modeling) and cognition (MoCA) were jointly modeled using group-based dual trajectory modeling (GBDTM). The optimal class solution was selected using information criteria and classification quality. Multinomial logistic regression (C1 reference) examined predictors of class membership. Generalized estimating equations (GEE) evaluated longitudinal changes in NIHSS, Barthel Index, IADL, and PHQ-9 across classes. Results:Among 515 participants, a 3-class solution was optimal: C1 sleep improvement-cognitive decline (29.51%, n = 152), C2 sleep decline-cognitive improvement (43.30%, n = 223), and C3 sleep improvement-cognitive improvement (27.18%, n = 140). For C2 (vs C1), widowhood, left-hemisphere infarction, and prior stroke history were associated with lower odds of class membership, whereas arrhythmia, atrial fibrillation, and baseline PSQI (T1) were associated with higher odds of class membership (all p < 0.05). For C3 versus C1, unmarried status was associated with higher odds of C3 membership, whereas left-hemisphere infarction, social medical insurance, and baseline PSQI were associated with lower odds of C3 membership. GEE showed no significant between-class differences in NIHSS, Barthel Index, or IADL at follow-up time points (all p > 0.05); PHQ-9 increased over time and was higher in C3 than C1 at T1 and T2. Conclusion:AIS survivors show heterogeneous and sometimes asynchronous joint sleep-cognition trajectories. Joint trajectory stratification and its correlates may inform targeted follow-up and individualized management.

Background/Objectives: Frailty and postoperative symptom burden are prevalent in older adults undergoing colorectal cancer (CRC) surgery, but their temporal, within-person interplay remains unclear. We aimed to investigate this bidirectional relationship using a Random Intercept Cross-Lagged Panel Model (RI-CLPM) to overcome the limitations of conventional models that conflate between-person and within-person variances. Methods: This prospective longitudinal study enrolled 242 older patients (≥60 years) undergoing CRC surgery. Frailty and symptom burden were evaluated preoperatively and at 1 week, 1, 3, 6, and 12 months postoperatively. An RI-CLPM was applied to decompose variance and estimate bidirectional cross-lagged effects across these six time points. Results: Both frailty and symptom burden peaked at 1 week postoperatively. The RI-CLPM demonstrated good fit (CFI = 0.984; RMSEA = 0.063). At the between-person level, frailty and symptom burden were strongly correlated (r = 0.90, p < 0.001). At the within-person level, greater symptom burden significantly predicted subsequent frailty worsening from 1 to 3 months (β = 0.268, p = 0.033) and 3 to 6 months (β = 0.378, p = 0.004) postoperatively. Conversely, frailty did not significantly predict subsequent symptom changes at any time point. Additionally, conventional CLPM yielded biased cross-lagged estimates compared to the RI-CLPM. Conclusions: The within-person longitudinal relationship between frailty and symptom burden is unidirectional. Elevated symptom burden prospectively predicts frailty worsening between 1 and 6 months postoperatively, whereas frailty does not drive subsequent symptom changes. This 1-to-6-month window represents a critical period for targeted symptom management to attenuate frailty progression in older CRC survivors.

The global burden of colorectal cancer (CRC) continues to rise, and the role of perioperative nutrition is shifting from "passive support" to an "active therapeutic" strategy. This narrative review synthesizes recent evidence on metabolic reprogramming and prehabilitation, immunonutrition and microbiome-guided approaches, enteral nutrition and long-term prognosis, and AI-enabled precision nutrition within CRC perioperative care. Findings indicate that multimodal prehabilitation-structured exercise combined with targeted nutrition-enhances metabolic flexibility, mitigates insulin resistance and inflammation, increases preoperative functional reserve, and improves postoperative complications and recovery trajectories. Immunonutrition (e.g., omega-3 fatty acids, arginine, glutamine) and probiotic/prebiotic interventions strengthen the intestinal barrier and recalibrate the immunosuppressive tumor microenvironment, with signals for reduced infections and overall complications. Enteral nutrition correlates with improved survival, while composite nutrition-inflammation indices (PNI, CONUT, GNRI) independently refine risk stratification and optimize prognostic modeling. Microbiome- and multi-omics-informed precision nutrition, supported by AI-based dietary assessment and dynamic monitoring, offers feasible pathways for individualized interventions. However, real-world implementation is constrained by under-recognition of malnutrition, resource limitations, and variability in Enhanced Recovery After Surgery (ERAS) adherence. Conclusions Establishing nutrition as a strategic pillar of CRC perioperative management is evidence-based. Priorities include consensus-driven, operational evaluation and intervention workflows; clear population stratification and biomarker-guided decision criteria; and strengthened long-term follow-up and multidisciplinary collaboration to translate and amplify the metabolic and immune benefits into tangible clinical gains.

ObjectiveThis study explored the correlation between different nutritional indicators and poststroke frailty (PSF), and compared the receiver operating characteristic curve of different nutritional indexes for PSF.MethodsThis cross-sectional study enrolled 266 adults with acute ischemic stroke. Frailty was assessed using the FRAIL scale. Nutritional status was assessed using Mini Nutritional Assessment Short Form (MNA-SF) and Nutritional Risk Screening 2002 (NRS2002); sarcopenia risk was evaluated by SARC-F. Anthropometric measures included Body Mass Index (BMI), Handgrip Strength (HGS), Triceps Skinfold Thickness (TST), Mid-Upper Arm Circumference (MUAC), Calf Circumference (CC), Weight-Adjusted Waist Index (WWI), and 4-Meter Walk Test (4-MWT). Logistic regression analysis was performed to analyze factors related to PSF, and receiver operating characteristic curve analysis was also used to compare the performance of these variables.ResultsThe frailty group (n = 89) had significantly lower values for HGS, 4-MWT speed, TST, MUAC, CC, albumin, and MNA-SF, but higher SARC-F and NRS2002 scores (all P < 0.05). Four indicators showed AUC > 0.65: MNA-SF (AUC = 0.70), SARC-F (AUC = 0.67), CC (AUC = 0.67), TST (AUC = 0.66). In elderly patients (≥65 years, n = 134), CC achieved the highest AUC (0.71). Logistic regression in separate models (each adjusted for age, gender, ADL, NIHSS, and stroke history) showed that higher MNA-SF, CC, TST, and 4-MWT as protective factors, while elevated SARC-F and NRS2002 were risk factors (all P < 0.05).ConclusionsMNA-SF, SARC-F, and CC are effective PSF predictors, with CC optimal in elderly patients. Integrating these tools could optimize frailty risk stratification, guiding targeted nutrition/resistance training to mitigate post-stroke frailty.

Objective:To explore nurse role reconstruction under the implementation of no-attendant care services in Shanghai hospitals, and to identify challenges and strategies for optimization. Methods:A phenomenological qualitative design was adopted. From June 1 to July 1, 2025, semi-structured face-to-face interviews were conducted with 14 registered nurses from no-attendant care wards in three tertiary hospitals in Shanghai. Data were transcribed verbatim and analyzed using Colaizzi's seven-step method. Two researchers independently coded, discrepancies were resolved through discussion and methodological arbitration, and results were validated through member checking to ensure rigor. Results:Four main themes and eleven subthemes were extracted: (1) Expanded Responsibilities and Intensified Workload: Significant Increase in Work Intensity; New Challenges in Professional Competence; Multidimensional Accumulation of Occupational Stress. (2) Positive Impacts on Patients and Families: Effective Relief of Family Care Burden; Enhanced Perceived Value of High-Quality Nursing. (3) Challenges in the Implementation Process: Blind Spots in Patient Safety Management; Need to Improve Nurse-Patient Communication Efficiency; Inadequate Mechanisms for Accountability. (4) Optimization Strategies: Establish a Legal Safeguard System; Improve Insurance Payment Coordination Mechanism; Strengthen Training Mechanisms for Nursing Assistants. A few minority or dissenting perspectives were incorporated as contextual modifiers. Conclusion:No-attendant care improves patient experience and alleviates family caregiving burden, but simultaneously places heavier physical, risk, and relational demands on nurses, highlighting the complexity of role reconstruction. This study demonstrates the essential features of nurses' lived experiences under this model and emphasizes the need for systemic support, such as legal frameworks, insurance coverage, and workforce training, to optimize care delivery and sustain professional resilience.

ObjectiveTo identify the facilitators and barriers to implementing physician-nurse joint clinic in tertiary general hospitals.MethodsA total of 14 nursing experts from a tertiary general hospital in Shanghai were selected as subjects in December 2024 by purposive sampling.Data were collected through semi-structured interviews.Data were analyzed using the Colaizzi 7⁃step analysis method.ResultsThree themes each for facilitators and barriers were identified.Facilitators included increased recognition of physician⁃nurse joint clinic,availability of essential conditions for implementation,and demonstrated effectiveness.Barriers included patient cognitive biases,negative attitudes among healthcare professionals,and limitations in objective conditions.ConclusionsPhysician⁃nurse joint clinic creates opportunities for the development of nursing disciplines but also is faced with challenges.It is essential to leverage their strengths and address limitations to provide higher⁃quality healthcare services for patients.

The incidence of skin and soft tissue nontuberculous mycobacteria infection (SSTNI) is increasing. But it may be challenging to diagnose and treat SSTNI. To summarize course, clinical features, diagnosis and treatment of SSTNI and discuss the association between SSTNI and procedures. A retrospective case series study was conducted among patients diagnosed with SSTNI after surgical procedures. Medical history was collected, disease course and characteristics were analyzed. 49 patients were collected. Among them, 39 (80 www.springer.com/00266 .

ObjectivesTo investigate the association between social and psychological factors and the risk of cognitive impairment following acute ischemic stroke.Materials and methodsA prospective study was conducted at Shanghai Tenth People’s Hospital from June 2021 to July 2022. The study focused on social and psychological factors, which were assessed using the Social Support Rating Scale (SSRS), Self-Perceived Burden Scale (SPBS), and Hamilton Depression Scale (HAMD) within 3 days after admission to the hospital. Cognitive function was evaluated using the Montreal Cognitive Assessment at 3 months post-stroke. Logistic hierarchical regression models were used to examine the association between these three indicators and cognitive impairment following a stroke.ResultsAmong these patients, cognitive function was assessed in 211 cases at the 3-month follow-up after the initial stroke event. At 3 months post-stroke, 118(55.9%) of the participants experienced cognitive impairment, while 93(44.1%) did not. The scores on the SPBS and HAMD showed significant associations with cognitive impairment at 3 months after stroke. The scores of SPBS [scores: 30~39 vs.<20 points, odds ratio (OR)=2.993 (1.135–7.896); scores: ≥40 vs.<20points, OR=7.382 (1.117–48.799); P=0.043] and the HAMD [scores: >7 vs.≤7 points, OR=3.287(1.362~7.936); P=0.008]. There were no significant associations observed between SSRS and PSCI.ConclusionEarly screening for depressive symptoms and focusing on self-perceived burden can be beneficial for decision support for clinicians and improve cognitive function recovery at the 3-month mark post-stroke.

Objectives: Cancer cachexia is a debilitating condition with widespread negative effects. The heterogeneity of clinical features within patients with cancer cachexia is unclear. The identification and prognostic analysis of diverse phenotypes of cancer cachexia may help develop individualized interventions to improve outcomes for vulnerable populations. The aim of this study was to show that the machine learning-based cancer cachexia classification model generalized well on the external validation cohort. Methods: This was a nationwide multicenter observational study conducted from October 2012 to April 2021 in China. Unsupervised consensus clustering analysis was applied based on demographic, anthropometric, nutritional, oncological, and quality-of-life data. Key characteristics of each cluster were identified using the standardized mean difference. We used logistic and Cox regression analysis to evaluate 1-, 3-, 5-y, and overall mortality. Results: A consensus clustering algorithm was performed for 4329 patients with cancer cachexia in the discovery cohort, and four clusters with distinct phenotypes were uncovered. From clusters 1 to 4, the clinical characteristics of patients showed a transition from almost unimpaired to mildly, moderately, and severely impaired. Consistently, an increase in mortality from clusters 1 to 4 was observed. The overall mortality rate was 32%, 40%, 54%, and 68%, and the median overall survival time was 21.9, 18, 16.7, and 13.6 mo for patients in clusters 1 to 4, respectively. Our machine learning-based model performed better in predicting mortality than the traditional model. External validation confirmed the above results. Conclusions: Machine learning is valuable for phenotype classifications of patients with cancer cachexia. Detection of clinically distinct clusters among cachexic patients assists in scheduling personalized treatment strategies and in patient selection for clinical trials. (c) 2023 Elsevier Inc. All rights reserved.

Pneumonia in ICU patients carries a bleak prognosis with high risk for cardiac dysfunction, largely due to cardiac infection and inflammation. Pseudomonas aeruginosa (P.a.) infection accounts nearly 20% of all cases of hospital acquired pneumonia with mortality rates >30%. P.a. infection induces a robust inflammatory response, which ideally enhances bacterial clearance. Unfortunately, excessive inflammation can also have negative effects, and often leads to cardiac dysfunction with associated morbidity and mortality. However, it remains unclear how P.a. lung infection causes cardiac dysfunction. Using a murine pneumonia model, we found that of P.a. infection of lungs led to severe cardiac left ventricular dysfunction and electrical abnormalities. More specifically, we found that neutrophil recruitment and release of S100A8/A9 in the lungs activates the TLR4/RAGE signaling pathways, which in turn enhance systemic inflammation and subsequent cardiac dysfunction. Paradoxically, global deletion of S100A8/A9 did not improve but aggravated cardiac dysfunction and immortality likely due to uncontrolled bacterial burden in the lungs and heart. Our results indicate that P.a. infection induced release of S100A8/9 is double-edged, providing increased risk for cardiac dysfunction yet limiting P.a. growth. Funding: NIH grants R01-AI 146252 and R21-AG 127783 Funding: NIH grants R01-AI 146252 and R21-AG 127783

Objective:This study investigated the consistency and determined the optimal threshold values of three scales in the diagnosis of insomnia of ischemic stroke (IS) patients.Methods:Participants in this study consisted of 569 acute IS patients. All 569 patients completed the assessment of the three insomnia scales. Insomnia of IS patients were assessed by Pittsburgh sleep quality index (PSQI), Insomnia Severity Index (ISI), and Athens insomnia scale (AIS). Also, basic patient information, neurological function, and activities of daily living were assessed. General information was compared between the insomnia group and the no-insomnia group. Cronbach's α coefficients, Cohen's Kappa consistency, Receiver operating characteristic (ROC) curve and DeLong's test analysis were used to analyze the reliability and diagnostic validity of PSQI, ISI, and AIS.Results:The PSQI and ISI showed high reliability with Cronbach's α of 0.875 and 0.858, respectively, while the AIS had an α coefficient of 0.734, demonstrating acceptable reliability. The PSQI, ISI, and AIS showed outstanding diagnostic ability with an AUC of 0.960 (95% CI: 0.946, 0.974), 0.911 (95% CI: 0.882, 0.941), and 0.876 (95% CI:0.837, 0.916). The best diagnostic cutoffs for PSQI, ISI, and AIS are ≥9, ≥15, and ≥8.Conclusion:Each of the three questionnaires has advantages and disadvantages when assessing insomnia. In the evaluation of insomnia in IS patients, the best questionnaire selection should be made according to the purpose of clinical evaluation and considering the sensitivity and specificity.

Objective:To investigate the influencing factors of adherence to exercise prehabilitation in older patients with colorectal cancer.Methods:Based on the capacity, opportunity, and motivation of behavior change (COM-B) model, 12 older colorectal tumors patients undergoing elective surgeries at a tertiary-care hospital in Shanghai between August 2022 and December 2022 were enrolled for the study through purposive sampling. The respondents were involved in semi-structured interviews. Directed content analysis of their data was conducted to extract themes.Results:A total of 3 themes and 8 sub-themes were deduced from the analysis, including capacity (physical ability to tolerate exercise intensity and psychological experience of worrying about exercise risks), opportunity (adequate information support and professional guidance and simple and feasible exercise prescriptions and prehabilitation conditions), motivation (the intrinsic drive to identify with the prehabilitation values, the positive drive of inherent exercise habits, the continuous drive of exercise benefits, and the dual inspiration of team spirit and family support). These themes and subthemes were identified as influencing factors of adherence to exercise prehabilitation in older patients with colorectal cancer.Conclusion:Prehabilitation in older patients with colorectal cancer is influenced by multiple factors. Healthcare professionals should enhance education, develop individualized prehabilitation programs, and improve the diversified social support system to enhance patients' adherence to prehabilitation exercise and maximize the benefits of prehabilitation.

BackgroundSince March 2022, Shanghai, China, has experienced a severe wave of SARS-CoV-2 transmission caused by the Omicron variant strain. The pandemic has severely constrained the local healthcare system. After treating critically ill COVID-19 patients, emergency nurses may experience some positive changes due to new insights or gains in their work, even if they have had traumatic experiences. This study aimed to explore the promoting factors of emergency nurses' post-traumatic growth during the COVID-19 pandemic in Shanghai. We hoped to provide a new perspective and theoretical basis for intervening in and promoting the psychological rehabilitation of medical staff after traumatic circumstances.MethodsThis study employed a qualitative design based on the phenomenological approach. 18 participants from the emergency department of a third-level class-A hospital in Shanghai who participated in treating COVID-19 patients were enrolled using purposive sampling. Data collection was through in-depth and semi-structured interviews and continued until reaching data saturation. The seven-step Colaizzi process was used for data analysis.ResultsThe investigation uncovered two themes and six subthemes. Internal factors contained self-affirmation, deliberate rumination, and cognitive restructuring, which constituted attitudes and behaviours that participants could subjectively determine. External factors included social support, transformational leadership, and role modelling, which constituted factors influenced by others or the environment.ConclusionsThe promoting factors of PTG of emergency nurses originated from different sources such as individuals, organizations, and society. In addition to good psychological adjustment of the individual, society, hospitals, and nursing managers should focus on establishing supportive PTG strategies. The ultimate purpose is to improve the retention rate and career growth of nurses.

Objectives Limited studies have systematically addressed the CT markers of predicting haemorrhagic transformation (HT). We aimed to (1) investigate the predictive ability of the imaging factors on multimodal CT for HT and (2) identify the key CT markers that can accurately predict HT while maintaining easy and rapid assessment in the early stage of stroke.Design and setting This was a prospective cohort study conducted in a tertiary hospital in Southwest China.Participants Patients with ischaemic stroke admitted within 24 hours after onset were included.Outcome measures The primary outcome was measured as the overall HT. The secondary outcomes were the presence of parenchymal haematoma, symptomatic HT and spontaneous HT.Results A total of 763 patients were included. The early hypodensity >1/3 of the middle cerebral artery (MCA) territory, Alberta Stroke Programme Early CT Score≤7, midline shift, hyperdense middle cerebral artery sign (HMCAS), poor collateral circulation, infarct core and penumbra was independently associated with the increased risk of HT (all p < 0.05). The sensitivity of midline shift for predicting HT was only 3.5%, whereas its specificity was 99.8%. The combination of the early hypodensity >1/3 of the MCA territory, midline shift and HMCAS showed a good predictive performance for HT (area under the curve 0.80, 95% CI 0.75 to 0.84).Conclusions Seven imaging factors on multimodal CT were independently associated with HT. The high specificity of midline shift suggests the need to consider it as an imaging indicator when assessing the risk of HT. The early hypodensity >1/3 of the MCA territory, midline shift and HMCAS was identified as the key CT markers for the early prediction of HT. The coexistence of the three key factors might be a valuable index for identifying individuals at high bleeding risk and guiding further treatments.

Objective The aim of this study was to assess the impact of short-term, hospital-based, supervised multimodal prehabilitation on elderly patients with colorectal cancer. Methods A single-center, retrospective study was conducted from October 2020 to December 2021, which included a total of 587 CRC patients who were scheduled to undergo radical resection. A propensity score-matching analysis was performed to reduce selection bias. All patients were treated within a standardized enhanced recovery pathway, and patients in the prehabilitation group received an additional supervised, short-term multimodal preoperative prehabilitation intervention. Short-term outcomes were compared between the two groups. Results Among the participants, 62 patients were excluded; 95 participants were included in the prehabilitation group and 430 in the non-prehabilitation group. After PSM analysis, 95 pairs of well-matched patients were included in the comparative study. Participants in the prehabilitation group had better preoperative functional capacity (402.78 m vs. 390.09 m, P<0.001), preoperative anxiety status (9% vs. 28%, P<0.001), time to first ambulation[25.0(8.0) hours vs. 28.0(12.4) hours, P=0.008], time to first flatus [39.0(22.0) hours vs. 47.7(34.0) hours, P=0.006], duration of the postoperative length of hospital stay [8.0(3.0) days vs. 10.0(5.0) days, P=0.007), and quality of life in terms of psychological dimensions at 1 month postoperatively [53.0(8.0) vs. 49.0(5.0), P<0.001]. Conclusion The short-term, hospital-based, supervised multimodal prehabilitation is feasible with a high degree of compliance in older CRC patients, which improves their short-term clinical outcomes.

Pseudomonas aeruginosa (P.a.) infection accounts for nearly 20% of all cases of hospital acquired pneumonia with mortality rates >30%. P.a. infection induces a robust inflammatory response, which ideally enhances bacterial clearance. Unfortunately, excessive inflammation can also have negative effects, and often leads to cardiac dysfunction with associated morbidity and mortality. However, it remains unclear how P.a. lung infection causes cardiac dysfunction. Using a murine pneumonia model, we found that P.a. infection of the lungs led to severe cardiac left ventricular dysfunction and electrical abnormalities. More specifically, we found that neutrophil recruitment and release of S100A8/A9 in the lungs activates the TLR4/RAGE signaling pathways, which in turn enhance systemic inflammation and subsequent cardiac dysfunction. Paradoxically, global deletion of S100A8/A9 did not improve but aggravated cardiac dysfunction and mortality likely due to uncontrolled bacterial burden in the lungs and heart. Our results indicate that P.a. infection induced release of S100A8/9 is double-edged, providing increased risk for cardiac dysfunction yet limiting P.a. growth.

Objective:To investigate the status of and obstacles to the implementation of enhanced recovery after surgery (ERAS) in tertiary-care general hospitals in China. Methods:Questionnaire on the Current Status of and Barriers to the Implementation of ERAS in Tertiary-Care Hospitals, a self-developed questionnaire, was used to conduct a survey of 77 tertiary hospitals from 21 provinces across China between May 2022 and June 2022. The participating hospitals were selected by convenience sampling. The questionnaire on the current implementation status of ERAS was mainly focused on the departments involved and the ERAS programs implemented, incorporating a total of 25 items of three dimensions, preoperative, intraoperative, and postoperative. The answer to each question consisted of 5 options from "never" to "always", which corresponded to 1 to 5 points on the scoring scale, with the higher scores indicating better implementation of the program concerned. In the questionnaire on barriers to ERAS implementation and recommendations, 10 items of two dimensions, including hospital management, and patient and caregiver, were concerned with the barriers to implementation. The answer to each question consisted of 5 options from "disagree" to "strongly agree", which corresponded to 1 to 5 points on the scoring scale, with the higher scores indicating the greater importance of the barriers. Results:ERAS programs were implemented in 73 (94.8%) hospitals. The best-implemented items were preoperative education (4.73±0.51), prevention and treatment of deep vein thrombosis (4.55±0.71), and postoperative follow-up (4.40±0.81). The items of poor implementation status were preoperative prehabilitation (2.71±1.40), preoperative oral carbohydrate drinks (3.03±1.49), and early ambulation after surgeries (3.04±1.22). The main obstacles to ERAS implementation included a lack of effective incentive systems, poor motivation among the medical and nursing staffs (3.21±0.93), a lack of disease-specific clinical implementation pathways (3.16±1.06), and a lack of experience in multidisciplinary teamwork (2.98±1.17). Conclusion:There is a high rate of ERAS implementation in tertiary general hospitals in China, but clinical implementation and dissemination are still confronted with many obstacles.