Hao Wu, Ling Wang, Yu Zhang
In this historical cohort study, comprehensive ERAS-based nursing intervention was associated with improved postoperative recovery after radical gastrectomy. Because of the non-randomized, single-centre design and the potential for residual and temporal confounding, these findings should be regarded as hypothesis-generating, and prospective multicentre randomized trials are needed to confirm effectiveness before widespread implementation.
BACKGROUND: Gastric cancer remains a significant global health burden, with surgical resection serving as the primary treatment modality. Postoperative recovery is often complicated by gastrointestinal dysfunction, nutritional deterioration, and psychological distress. The effectiveness of comprehensive nursing interventions based on enhanced recovery after surgery (ERAS) principles in Chinese gastric cancer patients remains inadequately investigated.
OBJECTIVE: To evaluate the effectiveness of a comprehensive nursing intervention program on postoperative recovery outcomes, nutritional status, and psychological well-being in patients undergoing radical gastrectomy for gastric cancer.
METHODS: This retrospective, single-centre historical cohort study included 178 patients who underwent radical gastrectomy for gastric cancer at a tertiary hospital. The control group (n = 86) received conventional perioperative nursing care during 2022, whereas the intervention group (n = 92) received a comprehensive ERAS-based nursing intervention during 2023-2024. Because the two groups were treated in different calendar periods, the design is regarded as a historical cohort study and is reported in accordance with the STROBE guideline. Primary outcomes were postoperative hospital stay and complication rate; secondary outcomes were gastrointestinal recovery, nutritional and psychological indicators, pain, and satisfaction. In addition to unadjusted comparisons, multivariable regression, 1:1 propensity-score matching, and inverse-probability-of-treatment weighting were used to adjust for baseline confounders including sex, and the Benjamini-Hochberg false-discovery-rate procedure was applied to secondary outcomes.
RESULTS: The intervention group demonstrated significantly shorter postoperative hospital stay (7.42 ± 1.44 vs. 10.56 ± 2.17 days, p < 0.001) and lower complication rate (14.1% vs. 31.4%, p = 0.006). Gastrointestinal function recovery was accelerated, with earlier time to first flatus (24.95 ± 5.16 vs. 36.28 ± 7.16 h, p < 0.001) and first ambulation (19.72 ± 4.54 vs. 29.28 ± 5.11 h, p < 0.001). Nutritional markers including serum albumin (34.94 ± 4.59 vs. 32.18 ± 4.38 g/L, p < 0.001) and prealbumin (205.02 ± 44.62 vs. 178.63 ± 43.31 mg/L, p < 0.001) were significantly higher. Psychological outcomes showed improvement with lower anxiety (HAMA: 10.08 ± 4.24 vs. 15.77 ± 4.48, p < 0.001) and depression scores (HAMD: 8.87 ± 5.01 vs. 12.45 ± 4.99, p < 0.001). Patient satisfaction was significantly higher (91.72 ± 5.73 vs. 80.07 ± 6.22, p < 0.001). After multivariable adjustment for age, sex, BMI, TNM stage, surgical factors and comorbidities, the intervention remained independently associated with shorter hospital stay (adjusted β = -3.13 days, 95% CI -3.67 to -2.59) and lower odds of complications (adjusted OR 0.25, 95% CI 0.10-0.58); propensity-score-matched and IPTW analyses yielded concordant estimates. Baseline nutritional and psychological values were comparable between groups, and all significant differences persisted after false-discovery-rate correction.
CONCLUSION: In this historical cohort study, comprehensive ERAS-based nursing intervention was associated with improved postoperative recovery after radical gastrectomy. Because of the non-randomized, single-centre design and the potential for residual and temporal confounding, these findings should be regarded as hypothesis-generating, and prospective multicentre randomized trials are needed to confirm effectiveness before widespread implementation.