Enhancing patient outcomes through nursing care in laparoscopic common bile duct exploration; a randomized control trail

Abstract

Background

When compared to open surgery, laparoscopic common bile duct exploration (LCBDE) is known to cause less discomfort and a faster recovery. This study examines the effect of the Enhanced Recovery After Surgery (ERAS) strategy on LCBDE outcomes.

Methods

In March 2021 to May 2024, 400 patients with LCBDE participated in randomized research. The six patient groups were: Multimodal Pain Management (n = 50), Standard Pain Management (n = 50), ERAS (n = 50), Preoperative Assessment (n = 100), Standard Preoperative Assessment (n = 100), and Standard Care (n = 50). The patient’s satisfaction, long-term recovery, pain, anxiety, and complication rates were among the outcomes that were measured.

Results

After the intervention, the mean anxiety level of the ERAS group was significantly lower (P < 0.05), and their rates of complications were also decreased. Reduced postoperative pain scores, which were 5 on day 1 and decreased to 3 by day 3, were the consequence of the multimodal pain management strategy inside ERAS. A 90% satisfaction rating and an average recovery period of five days were reported by the ERAS group. Long-term results in ERAS showed that the average time to return to work was only 25 days, and there was a decreased incidence of chronic pain.

Conclusion

The ERAS protocol enhances the short- and long-term course of recovery for patients with LCBDE, leading to increased satisfaction and better clinical outcomes. These results suggest that the ERAS method should be used as the gold standard for postoperative care for patients with LCBDE.

Introduction

Choledocholithiasis-induced acute cholangitis is a common clinical gastrointestinal condition with a quick onset that, in severe cases, can lead to sepsis, multi-organ functional impairment, and systemic inflammatory response syndrome. Treatment based on emergency biliary drainage is the main idea [1], However, the treatment of bile duct stones and biliary drainage should be combined for grade I and grade II acute cholangitis [2]. Patients are more likely to develop common duct stones as they get older [3]. Since Ludwig Courvoisier carried out the first common bile duct exploration (CBDE) with stone removal in 1890, the management of CBD stones has undergone significant modification [4].

Patients suffering CBD frequently experience bile reflux, intestinal obstruction, fever, jaundice, and gastric pain. Large, drug-resistant stones should be extracted as soon as possible in order to effectively treat the lesions. Minimally invasive procedures (such as laparoscopic exploration and lithotripsy) are generally used for the therapeutic treatment of tiny stones. However, because of the unique anatomy of the biliary system, postoperative severe pain and complications, and a delayed recovery of gastrointestinal function are unavoidable, adding to the physical and psychological strain on patients [5,6,7]. Both the patient and the surgeon may suffer greatly as a result of post-operative complications. It has been found that the upheavals that patients and their families experience may make them feel more stressed and anxious because they are already more susceptible to a difficult illness.

One nursing care paradigm that works well is collaborative nursing. Lott put up the self-care idea in 1992, emphasizing patient self-care to fully support patients’ arbitrary initiative. It fully cultivates and mobilizes patients’ capacity to engage in self-care, strengthens the collaborative nursing work between patients and nurses, and encourages patients and their families to actively participate in self-care [8]. It can more effectively meet the demands of nursing job and raise the standard of nursing services when compared to ordinary nursing. Nonetheless, in clinical settings, collaborative nursing is mostly utilized in the nursing care of patients undergoing haemodialysis, epilepsy, and COPD [9,10,11].

A crucial part of treatment is providing patients with supportive care to address their psychological, interpersonal, physiological (symptom management), educational, and practical requirements. One strategy to overcome care discontinuity and barriers to obtaining these resources is the active coordination of supportive care; however, feedback of this strategy’s efficacy beyond patient satisfaction surveys are deficient [12].

Our research intends to investigate the vital function that different nursing care facets play in the therapeutic process, specifically with regard to a technique called laparoscopic cholecystectomy (LCBDE). This is a common method for treating gallstones and involves removing the gallbladder with minimal invasiveness. Preoperative assessment is used prior to surgery; nursing care entails a thorough assessment to identify potential hazards related to the process. This include evaluating the patient’s health at the moment, their medical history, and any conditions that might make surgery more difficult. The intention is to get the patient and the medical staff ready for a successful and safe procedure.

Throughout the procedure, the nursing staff is vital in ensuring the patient’s cleanliness and hygiene to avoid infection. This is known as intraoperative assessment and care. They guarantee that all required materials and equipment are easily accessible and offer assistance to the surgical team as well. This cooperative effort is necessary to ensure that the surgery proceeds as planned. Nursing care is concentrated on controlling the patient’s discomfort, accelerating up their recuperation, and teaching them self-care techniques at home when postoperative management is applied. This includes offering guidance on wound care, recognizing early warning signs of difficulties, and recommending any necessary lifestyle adjustments.

Nursing care include not just the physiological elements of care but also emotional support and education throughout all of these stages. It helps to lower anxiety levels in the patient, minimize the possibility of problems, and improve overall satisfaction with the care received. The patient’s well-being is greatly enhanced by the nursing staff’s interventions, which are essential to the LCBDE.

Materials and methods

Study Design and Setting

The research utilized an online random assignment methodology, which was carried out between March 2021 and May 2024. Laparoscopic cholecystectomy (LCBDE) was performed on 400 patients. In order to assess how alternative nursing care perspectives affected patient outcomes, these patients were randomized at random to different intervention groups. For every patient taking part in this trial, informed consent was acquired. The hospital Medical Ethics Committee approved the study protocol (AOYY–YXLL–KJXM–21).

Inclusion Criteria

1.Adults (over 18 years old) planned for elective LCBDE.

2.Participants giving their consent in advance to take part in the study.

3.No prior bile duct surgical experience.

4.There is no sign of coagulopathy or bleeding problems.

5.There is no serious cardiopulmonary compromise that would make surgery or anesthesia contraindicated.

Exclusion Criteria

1.Patients with acute cholangitis require surgical intervention.

2.Patients with systemic infections/sepsis.

3.Patients with hepatic or renal dysfunction.

4.Patients having allergy to medications utilized in the ERAS protocol.

5.Patients with breastfeeding children or pregnant.

6.Patients with known psychiatric disorders.

Participants groups

400 patients who have LCBDE were enrolled in the study and were split up into the following groups:

1.Pre-operative Assessment Group (n = 100): This group of patients underwent a thorough pre-operative assessment to determine potential risks related to the treatment.

2.Standard Pre-operative Assessment Group (n = 100): Traditional pre-operative assessment techniques were followed by the patients.

3.Enhanced Recovery After Surgery (ERAS) Group (n = 50): The goal of the ERAS perioperative care pathway is to enhance patient outcomes by standardizing care procedures with an emphasis on maximizing both physiological and psychological recovery.

4.Standard Care Group (n = 50): Patients got standard postoperative treatment.

5.Multimodal Pain Management Group (n = 50): To better manage postoperative pain, this pain management strategy incorporates a number of pharmaceutical and non-pharmacological therapy.

6.Standard Pain Management Group (n = 50): Patients were treated using conventional methods of pain control.

Statistical tests

ANOVA and chi-square tests are among the suitable statistical tests that are used to assess the main outcome variables. Non-parametric statistical tests were utilized in the case of data that didn’t follow a normal distribution. P < 0.05 was used as the significance level for all statistical analyses performed using SPSS software (Version 25.0).

CONSORT 2010 statement

The CONSORT 2010 Statement standards, which include transparency in random sequence generation, allocation concealment, blinding, inclusion and exclusion criteria, and completeness of outcome data as illustrated in Fig. 1, are followed in the reporting to guarantee the study’s reproducibility [13].

Fig. 1

Consort 2010 flow chart

Data collection

Data were collected on various parameters, including complication rates, anxiety scores, surgical error rates, pain scores, recovery times, readmission rates, incidence of postoperative infections, patient satisfaction rates, and duration of hospital stay. Additionally, patient demographics such as age, gender, BMI, smoking history, comorbidities, and previous abdominal surgery were recorded.

Results

Patient demographics and baseline characteristics

The patient demographics and baseline characteristics are summarized in Table 1. The average age ranged from 40 to 54 years across the different intervention groups, with a gender distribution of approximately 50–70% male and 30–50% female. The BMI varied between 26 and 30 kg/m². Smoking history, comorbidities, and previous abdominal surgeries were also noted.

Table 1 Characteristics of the patients

Preoperative nursing care outcomes

Table 2 displays the results of preoperative nursing care. When compared to the conventional preoperative assessment group, Fig. 2, the complete preoperative assessment group and ERAS showed a substantial P < 0.05 reduced in mean anxiety scores post-intervention and a lower complication rate (10%).

Intraoperative nursing care outcomes

Intraoperative outcomes, including surgical error rates and pain scores, are presented in Table 2. Surgery error in ERAS nursing approach significantly reduces postoperative pain scores (5 on day 1 and 3 on day 3), which is substantial value when compared to other pain management techniques. Multimodal pain treatment in ERAS also exhibits reduced postoperative pain scores.

Table 2 Intraoperative nursing care

Fig. 2

Complication rate

Postoperative nursing care outcomes

Postoperative outcomes, such as recovery times and readmission rates, are detailed in Tables 2 and 3. Figure 3 shows that the ERAS group had the lowest readmission rate, the shortest average recovery period (5 days), the highest patient satisfaction rating (90%) and the return to normal activities. Furthermore, as Fig. 4 illustrates, we have seen that the ERAS group exhibits a substantial difference in terms of nausea, length of hospital stays, time to first meal, and satisfaction rate when compared to other nursing methods.

Table 3 Postoperative nursing care:

Fig. 3

Pre- and post-intervention

Fig. 4

Duration of Hospital stay and return to normal

Long-term outcomes

Long-term outcomes, including the incidence of bile leakage, chronic pain, and return to work times, are summarized in Table 4. The thorough ERAS group had a lower incidence of chronic pain (5%) and a quicker return to work (25 days) which also shows significant.

Table 4 Long-term outcomes

Overall patient satisfaction

A post-discharge questionnaire that assessed the standard of care, communication, pain management, and overall surgical experience was used in our study to measure patient satisfaction. According to the findings, the ERAS group and the preoperative evaluation group both had high patient satisfaction rates of 98% and 95%, respectively.

Discussion

Gallstones in the common bile duct (CBD) can be removed surgically by laparoscopic common bile duct exploration (LCBDE) [14]. According to earlier research, it offers a number of benefits over conventional surgical techniques, such as a quicker recovery period, a shorter hospital stay, and less discomfort than open surgery. It’s interesting to note that LCBDE still requires nursing support for the procedure’s preoperative, intraoperative, and postoperative care [15,16,17].

Our study highlights the significance of nursing care for patients with LCBDE and its impact on various patient outcomes. Improved patient outcomes, including reduced anxiety, fewer challenges, and higher satisfaction, have been associated with enhanced recovery procedures (ERAS) and preoperative evaluations. Multimodal pain management contributed to a considerable improvement in postoperative pain control scores by enhancing patient comfort and satisfaction. The nursing concept emphasizes the close contact between nursing links to ensure that perioperative nursing for patients with gallstones is very efficient [18, 19].

The ERAS approach has been shown to be effective in our research, especially when it comes to preoperative and intraoperative care [20]. Both the ERAS group and the comprehensive evaluation group had a lower rate of complications during the preoperative period, with ERAS showing a significantly lower mean anxiety index after the intervention (P < 0.05). This implies that, in comparison to conventional assessments, ERAS’s preoperative treatment is more effective at reducing anxiety.

ERAS nursing care distinguished itself during the intraoperative phase by significantly reducing the risk of surgical errors. Furthermore, ERAS’s multimodal pain management strategy reduced postoperative pain scores, which started at 5 on day 1 and decreased to 3 by day 3. This pattern suggests that ERAS’s pain management techniques are superior to conventional approaches in that they offer quick and long-lasting pain alleviation.

Over an average of 25 days, the ERAS group showed a decreased incidence of chronic pain and a quicker return to work. These results imply that ERAS improves long-term health outcomes in addition to maximizing short-term healing. When taken as a whole, these findings demonstrate the numerous benefits of ERAS and lend credence to its use as the gold standard in postoperative care.

Our findings provide credence to the idea that efficient nurse interventions, when implemented in accordance with the Enhanced Recovery After Surgery (ERAS) protocol, can shorten hospital stays and hasten the return to normal activities. In addition to helping patients feel less stressed both mentally and physically, this could have a big impact on healthcare systems by cutting costs and using resources more efficiently [21, 22].

In summary, the multimodal pain management of the ERAS protocol not only supports long-term recovery but also offers immediate and persistent pain relief, proving its superiority over conventional pain management techniques and its potential to become a new standard of care after surgery. However, this study has some limitations, such as a small sample size within the ERAS group, a brief follow-up time that might not capture long-term consequences, and a single-center design that might restrict how broadly the findings can be applied.

Conclusion

The ERAS protocol enhances the short- and long-term course of recovery for patients with LCBDE, leading to increased satisfaction and better clinical outcomes. These results suggest that the ERAS method should be used as the gold standard for postoperative care for patients with LCBDE.