The impact of nursing interventions on postoperative recovery in elderly patients undergoing surgical procedures: a systematic review and meta-analysis

Various types of nursing interventions differ in their effectiveness. This systematic review and meta-analysis aimed to evaluate the impact of nursing interventions on postoperative recovery in elderly patients undergoing surgical procedures. A systematic search was conducted in Scopus, PubMed, Web of Science, Embase, and MEDLINE from database inception through May 2026 using predefined search strategies. Studies were selected according to predefined Population, Intervention, Comparison, and Outcome (PICO) criteria. Methodological quality was independently assessed by two reviewers using the Joanna Briggs Institute (JBI) critical appraisal tools appropriate to each study design. Data were extracted and synthesized using both narrative and quantitative approaches. Meta-analysis was performed for postoperative complication outcomes. Postoperative complications were analyzed as dichotomous outcomes, and pooled Risk Ratios (RRs) with 95% confidence intervals (CIs) were calculated using random-effects models. Statistical heterogeneity was assessed using Cochran’s Q test and the I² statistic. Publication bias was evaluated through visual inspection of funnel plots and Egger’s regression test. Sixty-four studies involving 9,784 elderly surgical patients were included in this systematic review. More than 65% of the studies were published between 2024 and 2025, reflecting a growing recent interest in perioperative nursing care. Five studies evaluated pharmacological nursing-related interventions, while 59 assessed non-pharmacological interventions delivered or coordinated within nursing-led perioperative care pathways. These interventions included early mobilization, ERAS-based care, nutritional and psychological support, patient education, rehabilitation strategies, discharge planning, continuity-of-care models, and pain management approaches. Overall, nursing interventions were associated with a significantly reduced risk of postoperative complications compared with standard care (RR = 0.38, 95% CI: 0.31–0.46). However, substantial heterogeneity was observed across studies, likely reflecting differences in intervention components, patient populations, clinical settings, and outcome measurement methods. To address this variability and improve interpretability, studies were categorized into 30 predefined intervention groups based on their clinical purpose and underlying mechanism of action. Nursing-led perioperative interventions appear to be associated with improved postoperative recovery outcomes in elderly surgical patients, particularly in reducing postoperative complications. However, the certainty of this evidence is limited by substantial heterogeneity, variability in intervention design and outcome measurement, and methodological limitations across the included studies. In addition, potential publication bias may have influenced the observed effect estimates. Therefore, although the findings suggest a beneficial role for nursing interventions in perioperative care, they should be interpreted with caution. High-quality, multicenter randomized controlled trials with standardized intervention protocols and harmonized outcome measures are needed to confirm the effectiveness of specific nursing strategies and to strengthen the robustness of future evidence syntheses.