Association of Watson-based humanistic fast track surgery with stoma colorectal cancer recovery: A propensity matched study

doi:10.4240/wjgs.v18.i7.120222

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Publication Name

World Journal of Gastrointestinal Surgery

ISSN

1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Surg. Jul 27, 2026; 18(7): 120222
Published online Jul 27, 2026. doi: 10.4240/wjgs.v18.i7.120222

Association of Watson-based humanistic fast track surgery with stoma colorectal cancer recovery: A propensity matched study

Dan Jiang, Feng-Jia Shang, Wei Yu

Dan Jiang, Feng-Jia Shang, Wei Yu, Department of Colorectal Surgery, The Second Norman Bethune Hospital of Jilin University, Changchun 130000, Jilin Province, China

Co-first authors: Dan Jiang and Feng-Jia Shang.

Author contributions: Jiang D and Yu W designed the research and analyzed the data; Jiang D and Shang FJ performed the research, and collected and verified the clinical data; Jiang D wrote the paper; Shang FJ and Yu W critically revised the manuscript for important intellectual content; Yu W supervised the study; and all authors have read and approved the final manuscript. Jiang D and Shang FJ contributed equally to this work as co-first authors.

AI contribution statement: This manuscript was written entirely by human authors without the use of artificial intelligence tools.

Institutional review board statement: This retrospective study was reviewed and approved by the Institutional Review Board of the Second Norman Bethune Hospital of Jilin University (No. 2026-097). All study procedures were conducted in accordance with the ethical standards of the institutional committee and the Declaration of Helsinki.

Informed consent statement: The requirement for written informed consent was explicitly waived by the Institutional Review Board of the Second Norman Bethune Hospital of Jilin University because this was a retrospective observational study using anonymized patient information. All data were handled with strict confidentiality to protect patient privacy.

Conflict-of-interest statement: All authors declare that they have no financial or personal relationships with other people or organizations that could inappropriately influence or bias their work. There are no conflicts of interest associated with this research or its publication.

STROBE statement: The authors have read the STROBE Statement checklist of items, and the manuscript was prepared and revised according to the STROBE Statement checklist of items.

Data sharing statement: The original anonymized dataset and the statistical analysis code used to support the findings of this study are available from the corresponding author upon reasonable request.

Corresponding author: Wei Yu, Associate Chief Physician, Department of Colorectal Surgery, The Second Norman Bethune Hospital of Jilin University, No. 4026 Yatai Street, Changchun 130000, Jilin Province, China. 15526891356@163.com

Received: February 24, 2026
Revised: March 18, 2026
Accepted: May 14, 2026
Published online: July 27, 2026
Processing time: 157 Days and 21.4 Hours

Abstract

BACKGROUND

While fast track surgery (FTS) protocols have optimized physiological recovery in colorectal cancer (CRC), their highly procedural nature often overlooks the individualized humanistic needs of patients, particularly those facing the psychological challenges of a stoma.

AIM

To evaluate whether an integrated Watson-based FTS (Watson-FTS) care model is associated with measurable improvements in physiological recovery, complication rates, and humanistic process of care indicators in CRC patients undergoing stoma surgery.

METHODS

A retrospective cohort study was conducted involving 312 patients (Watson-FTS group, n = 165; routine care group, n = 147). To control for confounding factors such as age, surgical approach, and baseline psychological distress, 1:1 propensity score matching was performed, resulting in 125 well-matched pairs (n = 250). Primary outcomes included time to first flatus and overall postoperative complications. Secondary outcomes, including nutritional markers [prealbumin (PA)] and protocol adherence, were analyzed using generalized estimating equations (GEEs).

RESULTS

In the matched cohort, the Watson-FTS group demonstrated a significantly shorter mean time to first flatus [52.4 ± 10.8 hours vs 68.1 ± 13.5 hours; adjusted beta = -15.2 hours, 95% confidence interval (CI): -18.4 to -12.0, P < 0.001]. The incidence of overall postoperative complications was significantly lower in the Watson-FTS group [15.2% vs 30.4%; adjusted odds ratio (aOR) = 0.39, 95%CI: 0.21-0.72, P = 0.003], specifically regarding stoma-related events (4.8% vs 12.8%, P = 0.024). Longitudinal GEE analysis revealed a significantly faster recovery trajectory for PA levels in the Watson-FTS group (interaction P < 0.001) and superior protocol adherence by postoperative day 5 (91.2% vs 70.4%, P < 0.001). Multivariable regression confirmed the Watson-FTS intervention as the strongest independent predictor for successful early recovery (aOR = 3.62, P < 0.001).

CONCLUSION

Integrating Jean Watson’s humanistic caring theory into the FTS pathway is associated with enhanced physiological and functional recovery. The Watson FTS model is linked to a lower incidence of complications and more stable metabolic recovery, offering a superior alternative to standardized procedural care for patients with colorectal stomas.

Keywords: Colorectal cancer; Intestinal stoma; Fast track surgery; Humanistic nursing; Propensity score matching

Core Tip: This study innovatively integrates Jean Watson’s humanistic caring theory into fast track surgery (Watson-FTS) for colorectal cancer patients with stomas. While traditional fast track surgery protocols prioritize physiological milestones, they often overlook individualized psychological needs. Utilizing robust propensity score matching and generalized estimating equations for longitudinal analysis, we demonstrated that the Watson-FTS model significantly accelerates gastrointestinal recovery, reduces stoma-specific complications, and improves postoperative nutritional trajectories. This holistic approach proves that addressing humanistic needs enhances protocol adherence, offering a clinically superior alternative to standardized procedural care for vulnerable ostomy patients.