Randomized Clinical Trial
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 28, 2025; 31(8): 102331
Published online Feb 28, 2025. doi: 10.3748/wjg.v31.i8.102331
Evidence-based control of stress response on intraoperative physiological indexes and recovery of patients undergoing gastrointestinal surgery
Chen-Dong Yuan, Bao-Zhu Zhou, Ning-Yan Wang, Qing-Qing Wan, Zhen-Zhen Hu
Chen-Dong Yuan, Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Bao-Zhu Zhou, Ning-Yan Wang, Qing-Qing Wan, Zhen-Zhen Hu, Department of Anesthesiology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Author contributions: Yuan CD, Zhou BZ, and Wang NY was the guarantor and designed the study; Yuan CD and Hu ZZ participated in the acquisition, analysis, and interpretation of the data, and drafted the initial manuscript; Yuan CD and Wan QQ revised the article critically for important intellectual content.
Institutional review board statement: The study was reviewed and approved by the First Affiliated Hospital of Nanchang University, Jiangxi Province.
Clinical trial registration statement: As the author’s organization and ethics committee did not require clinical trial registration prior to the study.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhen-Zhen Hu, Department of Anesthesiology, The First Affiliated Hospital of Nanchang University, No. 17 Yongwai Main Street, Donghu District, Nanchang 330006, Jiangxi Province, China. ndyfyhzz9989@163.com
Received: November 13, 2024
Revised: December 11, 2024
Accepted: January 14, 2025
Published online: February 28, 2025
Processing time: 70 Days and 21.8 Hours
Abstract
BACKGROUND

Although the 2021 Chinese Clinical Practice Guidelines for Enhanced Recovery after Surgery (ERAS) provide recommendations for ERAS in gastrointestinal surgery, the clinical application of standard ERAS nursing models is challenging due to the variety of diseases involved in gastrointestinal surgery and the complex factors contributing to patient stress responses. Moreover, stress responses are more severe in older adult patients. Therefore, precision medicine is required to improve the quality of nursing care and promote postoperative recovery in gastrointestinal surgery.

AIM

To establish an evidence-based ERAS model based on stress response nursing care and demonstrate nursing benefits through clinical practice.

METHODS

This randomized clinical trial first established an evidence-based nursing ERAS protocol in older adult patients based on literature related to perioperative nursing measures for gastrointestinal surgery stress response. Next, 392 older adult patients who underwent gastrointestinal surgery and were admitted to our hospital between December 2021 and June 2023 were categorized into two groups to receive evidence-based (study group) or conventional (control group) ERAS nursing models, respectively. Intraoperative physiological parameters during surgery and postoperative recovery indicators were compared between the groups.

RESULTS

Among 64 domestic and international studies, the stress responses of older adult patients mainly included emotional anxiety, sleep disorders, gastrointestinal discomfort, physical weakness, pain, and swelling. The appropriate nursing interventions included comprehensive psychological counseling, pre- and postoperative nutritional support, temperature control, pain management, and rehabilitation training. Compared with the control group, the study group showed lower heart rate, mean arterial pressure, blood glucose level, and adrenaline level; shorter duration of drainage tube placement, time to first flatus, time to first ambulation, and postoperative hospital stay; lower anxiety scores on postoperative day 3; and lower incidences of postoperative infection, obstruction, poor wound healing, and gastrointestinal reactions were lower in the study group (all P < 0.05).

CONCLUSION

The evidence-based nursing measures targeting stress responses based on the conventional ERAS nursing model resulted in stable intraoperative physiological parameters during surgery, promoted postoperative recovery, and reduced the incidence of complications.

Keywords: Older adult patients; Gastrointestinal surgery; Stress response; Evidence-based nursing; Enhanced recovery after surgery

Core Tip: This study established an evidence-based enhanced recovery after surgery model with stress response nursing care as its foundation, and demonstrated nursing benefits through clinical practice, providing a reference and a guide for optimizing perioperative nursing protocols for older adult patients undergoing gastrointestinal surgery. Our results showed that patients who received the evidence-based nursing measures targeting stress responses showed more stable intraoperative physiological parameters, improved postoperative recovery, and a reduced incidence of complications compared with the control group that received the standard enhanced recovery after surgery nursing model.