Effect of enhanced recovery after surgery nursing on gastrointestinal recovery function and life quality in patients laparoscopic cholecystectomy

Abstract

BACKGROUND

Laparoscopic cholecystectomy is the primary method for treating cholecystitis. Traditional postoperative care has poor outcomes for patient recovery. The enhanced recovery after surgery (ERAS) model is increasingly applied in clinical settings. However, the impact of this nursing model on patients undergoing laparoscopic cholecystectomy remains unclear.

AIM

To evaluate the effects of ERAS on postoperative gastrointestinal recovery and quality of life in patients undergoing laparoscopic cholecystectomy.

METHODS

This is a retrospective study design in which we collected clinical data from 120 patients who underwent laparoscopic cholecystectomy at our hospital. Patients were divided into a control group (n = 60) and a study group (n = 60) based on the type of nursing intervention. The control group received conventional care, while the study group received ERAS. We assessed gastrointestinal recovery, quality of life, and nursing satisfaction before and after the nursing interventions in both groups.

RESULTS

After nursing care, the gastrointestinal recovery times (time to bowel sounds return, time to flatus, time to first bowel movement, and time to first meal) in the study group were significantly shorter than those in the control group, with statistically significant differences between the two groups (P < 0.05). Additionally, the quality of life in the study group was significantly higher than that in the control group (P < 0.05). The nursing satisfaction in the study group was also significantly higher than that in the control group, with statistically significant differences between the two groups (P < 0.05).

CONCLUSION

In summary, compared to conventional nursing, ERAS can more rapidly promote gastrointestinal recovery and improve the quality of life in patients after laparoscopic cholecystectomy. Further clinical application of this approach is warranted.

Key Words: Enhanced recovery after surgery; Gastrointestinal recovery; Laparoscopic cholecystectomy; Nursing satisfaction; Quality of life

Core Tip: Laparoscopic cholecystectomy is the primary method for treating cholecystitis. Traditional postoperative care has poor outcomes for patient recovery. The aim of this study is to evaluate the effects of enhanced recovery after surgery (ERAS) on postoperative gastrointestinal recovery and quality of life in patients undergoing laparoscopic cholecystectomy. Compared to conventional nursing, ERAS can more rapidly promote gastrointestinal recovery and improve the quality of life in patients after laparoscopic cholecystectomy. By improving gastrointestinal recovery, quality of life, and nursing satisfaction, while reducing pain, ERAS provides valuable insights for modern surgical care.

INTRODUCTION

Acute cholecystitis is among the most common gastrointestinal conditions encountered in medical practice, which is an inflammation of the gallbladder due to blockage and bacterial infection of the cystic duct, with over 90% of cases linked to gallstones or cholelithiasis[1,2]. Patients typically present with symptoms such as severe biliary colic, abdominal distension, nausea, and vomiting[3]. Without timely and appropriate intervention, acute cholecystitis may become complicated due to hidden symptoms and delayed diagnosis, potentially advancing to gangrenous cholecystitis and perforation, resulting in peritonitis[4]. Studies indicate that each year, about 2%-4% of gallbladder stone disease patients exhibit symptoms, with yearly incidence rates for acute cholecystitis, acute pancreatitis, and obstructive jaundice being 0.3%-0.4%[5]. Without proper and prompt treatment, acute cholecystitis and cholangitis in adults can lead to fatal outcomes[5].

Laparoscopic cholecystectomy is currently the primary method for treating acute calculous cholecystitis, mainly due to its minimally invasive nature, reduced postoperative pain, and faster recovery time compared to traditional open surgery[6-8]. In recent years, despite continuous improvements in surgical techniques, effective postoperative nursing models still play a crucial role in patient recovery and overall surgical outcomes. Postoperative care is crucial for recovery after surgery, yet conventional care models tend to emphasize the disease and complications after surgery rather than physical recuperation[9,10]. These traditional nursing approaches often overlook the importance of early mobilization, nutritional support, and proactive pain management, which may be detrimental to the patient’s natural healing process.

Lately, there has been increasing interest in enhanced recovery after surgery (ERAS), which involves a multidisciplinary team working together to speed up recovery during perioperative care[11]. ERAS includes a comprehensive set of evidence-based interventions, including preoperative patient education and counseling, optimization of anesthesia and analgesia protocols, early postoperative mobilization and feeding, meticulous fluid management, and attention to psychological support[12,13]. The implementation of ERAS protocols has achieved significant success in a wide range of surgical procedures, resulting in significant reductions in hospital stay, fewer postoperative complications, improved patient satisfaction, and substantial cost savings for healthcare systems[14]. Studies have shown that implementing the ERAS protocol may not only hasten the return of hip joint function and self-care abilities but also alleviate anxiety and boost quality of life[15,16]. The program has been put into place to enhance care before, during, and after surgery to speed up recovery[17]. Furthermore, the ERAS program has markedly improved the speed of functional recovery and lessened the necessity for extensive care after surgical procedures[18].

While the benefits of ERAS care models have been widely applied in elective surgery, they are less commonly used in patients with acute cholecystitis. Patients with acute cholecystitis often experience more severe inflammation, pain, and physiological disturbances. The presence of acute inflammation can impair gastrointestinal motility, increase the risk of postoperative ileus, and exacerbate pain. Therefore, studying the application effect of ERAS care models in patients undergoing laparoscopic cholecystectomy is of great significance. In summary, this study aims to evaluate the impact of enhanced recovery care protocols on gastrointestinal recovery and quality of life in patients undergoing laparoscopic cholecystectomy, with the aim of providing valuable insights into the effectiveness of enhanced recovery care in optimizing postoperative recovery for patients with acute cholecystitis.

MATERIALS AND METHODS

General information

This is a retrospective study design. We collected clinical data from a total of 120 patients who underwent laparoscopic cholecystectomy at our hospital. Data collection spanned from January 2023 to December 2024. Based on the type of care received, patients were divided into two groups: The study group received ERAS care (n = 60), and the control group received conventional care interventions (n = 60). Clinical information was collected for both groups.

Inclusion and exclusion criteria

Inclusion criteria: (1) Clinically diagnosed with acute cholecystitis[19]; (2) No contraindications to general anesthesia and laparoscopic surgery; (3) No history of mental illness; and (4) Complete medical records and follow-up data.

Exclusion criteria: (1) Patients with severe visceral dysfunction; (2) Patients with coagulation disorders, gastrointestinal dysfunction, or immune or metabolic abnormalities that may affect surgical procedures and outcomes; (3) Patients with systemic infections, gallbladder perforation, or necrosis; (4) Patients with malignant tumors or other acute abdominal conditions; (5) Patients with a history of abdominal surgery; (6) Pregnant or breastfeeding women; and (7) Patients with incomplete medical records or missing data.

Nursing methods

The control group received conventional care methods. The control group was provided with a conventional care model. Patients were informed in advance about the role and necessity of surgical treatment for the disease, and were instructed on surgery-related precautions and cooperation matters. One day before the operation, the surgical procedure, expected effects, and possible postoperative complications were explained to the patient and their family to prepare them psychologically, and psychological counseling was conducted to reduce their mental stress. Vital signs were monitored during the operation. Postoperatively, analgesic interventions were administered, and the recovery of gastrointestinal function was observed.

The study group adopted an ERAS protocol: (1) Health education: Nursing staff showed patients surgical models and simulated the surgical process by playing surgical videos to help them understand the surgical procedures. Health education leaflets were distributed to patients, detailing the surgical process and prognosis. Questions from patients were actively answered, and the importance of rapid recovery surgical nursing was explained, guiding patients to actively cooperate; (2) Psychological nursing: Nursing staff proactively communicated with patients, paying attention to their emotional changes and guiding them to express their true feelings. Nursing staff expressed understanding and respect to enhance patient trust. Language skills were used to guide patients, instructing them to appropriately vent emotions through various channels and adjust their psychological state. Listening to light music, such as classical music, folk music, and piano music, helped patients forget worries and maintain physical and mental relaxation. Shifting attention through activities such as playing chess, reading, singing, and dancing reduced psychological stress and burden. Talking with relatives and friends helped express emotions and maintain a good psychological state. Psychological nursing was implemented throughout the perioperative period. When patients were awake after surgery, they were promptly encouraged and comforted to further enhance their confidence in recovery; (3) Gastrointestinal preparation: The day before surgery, a semi-liquid diet was maintained for dinner, such as millet porridge and soft noodles. Eight hours before surgery, 500 mL of warm 10% glucose injection was taken orally. Two hours before surgery, 250 mL of warm glucose injection was taken orally to complete bowel cleansing and prepare the gastrointestinal tract; (4) Warming care: Before surgery, nursing staff adjusted the operating room temperature and humidity to a comfortable state and pre-warmed the operating table. During the patient’s surgery, all intravenous fluids and irrigation solutions used were pre-warmed, and other parts of the patient’s body were effectively covered to reduce exposure and prevent hypothermia; (5) Early ambulation: After surgery, patients were returned to the ward after anesthesia recovery. The patient’s feelings were asked, and they were assisted to maintain a comfortable position to improve their comfort. Patients were instructed to perform limb exercises in bed. Four to six hours after surgery, if the patient had no discomfort, they could get out of bed to urinate and turn over appropriately in bed. Bed sheets were kept flat to prevent pressure ulcers. Twenty-four hours after surgery, patients were guided to perform simple activities at the bedside according to their tolerance, with nursing staff or family members accompanying them to avoid falls. Forty-eight hours after surgery, patients could perform simple activities in the corridor with family accompaniment, controlling the amount of activity to avoid overexertion; (6) Pain management: After surgery, analgesics were appropriately selected according to the patient’s pain level, as prescribed by the doctor, to help reduce pain. Patient’s family members were instructed to chat with the patient and divert attention through watching TV, playing games, and other methods to relieve pain. If the patient’s irritability and anxiety were severe, a pain pump could be used as prescribed by the doctor to avoid pain-induced stress reactions; (7) Environmental care: Nursing staff maintained gentle movements, prepared clean and tidy bed sheets and bedding for patients, effectively adjusted indoor lighting, maintained fresh indoor air, and provided a good environment for patients to rest. A “quiet please” sign was hung on the door to maintain indoor quiet and ensure patients had sufficient rest; and (8) Dietary care: If the patient had no abnormalities after surgery, they could drink a small amount of millet porridge or sugar water 6 hours after surgery, maintaining a liquid diet; two days after surgery, a semi-liquid diet was maintained, gradually transitioning to a normal diet. A diet high in vitamins and protein was maintained, with appropriate increases in fresh fruits and vegetables, mainly a light diet, to prevent constipation.

Observation indicators

Gastrointestinal recovery: This will be measured by monitoring the return of bowel sounds, passage of flatus and stool, time to first oral intake, and length of hospital stay. Quality of life[20]: The World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire will assess quality of life across four domains: Physical, psychological, social, and environmental. Each domain is scored out of 100, with higher scores indicating better quality of life. Pain assessment[21]: Pain levels will be evaluated using the visual analog scale (VAS) at baseline, postoperative days 1, 3, and 5. The VAS ranges from 0 (no pain) to 10 (severe pain), with detailed descriptors for mild (1-3), moderate (4-6), and severe (7-10) pain levels. Nursing satisfaction: A custom questionnaire will assess patient satisfaction with nursing care, with scores indicating “dissatisfaction” (below 60), “basic satisfaction” (60-85), or “very satisfied” (above 85). The overall satisfaction rate will be calculated as the percentage of patients reporting “basic satisfaction” or “very satisfied”.

Statistical analysis

Data will be analyzed using SPSS version 26.0. Continuous variables will be presented as mean ± SD and compared between groups using independent t-tests. Categorical variables will be presented as n (%) and analyzed using χ² tests. The WHOQOL-BREF domain scores will be calculated according to the official scoring manual, with each domain transformed to a 0-100 scale. Statistical significance will be defined as P < 0.05.

RESULTS

General data of the two groups

There were no statistically significant differences in general data between the two groups of patients (P > 0.05). The mean age in the ERAS group was 53.0 ± 9.0 years, and in the conventional care group, it was 54.0 ± 9.5 years (P = 0.452). In the ERAS group, males accounted for 48.3% (29 patients) and females 51.7% (31 patients), while in the conventional care group, males accounted for 45.0% (27 patients) and females 55.0% (33 patients; P = 0.714). In the ERAS group, American Society of Anesthesiologists (ASA) class I accounted for 45.0% (27 patients), class II for 38.3% (23 patients), and class III for 16.67% (10 patients), while in the conventional care group, ASA class I accounted for 43.3% (26 patients), class II for 38.3% (23 patients), and class III for 18.33% (11 patients; P = 0.967). In summary, the two groups of patients were comparable in these general data (Table 1). The distribution of ASA grades is shown in Figure 1A.

Figure 1 Distribution of American Society of Anesthesiologists grades, recovery of gastrointestinal function, quality of life, and nursing satisfaction between the two groups. A: Distribution of American Society of Anesthesiologists grades; B: Recovery of gastrointestinal function; C: Quality of life; D: Nursing satisfaction. ASA: American Society of Anesthesiologists; WHOQOL-BREF: World Health Organization Quality of Life-BREF; Phys: Physical; Psych: Psychological; Envir: Environment.

Table 1 General information of between the two groups of patients, n (%).

Indicator	Enhanced recovery group (n = 60)	Conventional care group (n = 60)	P value
Age (years), mean ± SD	53.0 ± 9.0	54.0 ± 9.5	0.452
Gender			0.714
Male	29 (48.3)	27 (45.0)
Female	31 (51.7)	33 (55.0)
ASA classification			0.967
Class I	27 (45.0)	26 (43.3)
Class II	23 (38.3)	23 (38.3)
Class III	10 (16.67)	11 (18.33)
Comorbidities
Hypertension	24 (40.0)	20 (33.3)	0.449
Diabetes	6 (10.0)	11 (18.3)	0.191
Smoking history			0.637
Yes	12 (20.0)	10 (16.7)
No	48 (80.0)	50 (83.3)
Alcohol consumption			1.000
Yes	7 (11.7)	7 (11.7)
No	53 (88.3)	53 (88.3)
History of abdominal surgery	16 (26.7)	17 (28.3)	0.838
Preoperative antibiotics	10 (16.7)	9 (15)	0.803

ASA: American Society of Anesthesiologists.

Gastrointestinal function recovery in the two groups

After nursing intervention, the ERAS group had significantly shorter times for bowel sound recovery (28.87 ± 8.50 hours), time to first flatus (39.15 ± 9.46 hours), time to first defecation (41.15 ± 9.46 hours), and time to first feeding (32.15 ± 6.06 hours) compared to the conventional care group, which were (47.70 ± 10.20 hours), (49.90 ± 8.55 hours), (55.38 ± 11.05 hours), and (45.38 ± 5.68 hours), respectively (P < 0.05). Furthermore, the time to first ambulation after surgery in the ERAS group (2.15 ± 1.00 days) was also significantly shorter than in the conventional care group (3.27 ± 1.75 days), with statistical significance (P < 0.05; Figure 1B).

Comparison of quality of life between the two groups

The results showed that after nursing intervention, the ERAS group scored significantly higher than the conventional care group in all dimensions of the WHOQOL-BREF questionnaire (P < 0.001). The mean WHOQOL-BREF physical score for the ERAS group was 56.35 ± 5.07, significantly higher than the 40.02 ± 3.61 for the conventional care group (P < 0.001). The mean WHOQOL-BREF psychological score for the ERAS group was 70.75 ± 5.33, also significantly higher than the 59.13 ± 6.44 for the conventional care group (P < 0.001). This indicates that the ERAS group experienced better emotions, cognitive function, and self-esteem. The mean WHOQOL-BREF social score for the ERAS group was 77.22 ± 6.30, also significantly higher than the 62.55 ± 5.73 for the conventional care group (P < 0.001). The mean WHOQOL-BREF environment score for the ERAS group was 48.75 ± 6.31, significantly higher than the 41.92 ± 4.93 for the conventional care group (P < 0.001; Table 2, Figure 1C).

Table 2 Comparison of the World Health Organization Quality of Life-BREF scores between the two groups, mean ± SD.

Indicator	Enhanced recovery group (n = 60)	Conventional care group (n = 60)	P value
WHOQOL-BREF physical	56.35 ± 5.07	40.02 ± 3.61	< 0.001
WHOQOL-BREF psychological	70.75 ± 5.33	59.13 ± 6.44	< 0.001
WHOQOL-BREF social	77.22 ± 6.30	62.55 ± 5.73	< 0.001
WHOQOL-BREF environment	48.75 ± 6.31	41.92 ± 4.93	< 0.001

WHOQOL-BREF: World Health Organization Quality of Life-BREF.

Comparison of the VAS scores

Before nursing intervention, there was no significant difference in preoperative pain scores between the ERAS group and the conventional care group (P = 0.936), and the scores of the two groups were basically the same (7.58 ± 1.22 vs 7.57 ± 1.03). On postoperative days 1, 3, and 5, the pain scores of the ERAS group were significantly lower than those of the conventional care group (P < 0.001; Table 3).

Table 3 Comparison of the visual analog scale scores between the two groups, mean ± SD.

Indicator	Enhanced recovery group (n = 60)	Conventional care group (n = 60)	P value
Before surgery	7.58 ± 1.22	7.57 ± 1.03	0.936
1 day after surgery	4.58 ± 0.87	5.57 ± 0.98	< 0.001
3 days after surgery	2.37 ± 0.48	4.62 ± 0.52	< 0.001
5 days after surgery	1.98 ± 0.29	3.90 ± 0.30	< 0.001

Nursing satisfaction

After nursing intervention, there was a statistically significant difference in nursing satisfaction between the ERAS group and the conventional care group (P < 0.05), with nursing satisfaction rates of 95.0% (57/60) and 75.0% (45/60), respectively (Figure 1D).

DISCUSSION

The ERAS nursing model, validated through empirical evidence, significantly improves postoperative recovery and clinical outcomes via evidence-based medicine. Its successful adoption in laparoscopic surgeries across departments shows that ERAS protocols improve gastrointestinal recovery, and shorten recovery times[22]. Laparoscopic myomectomy patients benefit from ERAS nursing with faster return of bowel function, shorter hospital stays, and reduced bladder irritation[23,24]. This underscores the clinical value of ERAS surgical nursing for enhanced patient recovery and satisfaction, alongside fewer complications.

Compared to conventional care, ERAS nursing significantly shortened recovery times for gastrointestinal function, passage of flatus, first bowel movement, and first feeding (P < 0.05). ERAS also facilitated earlier ambulation, reduced hospital stays (P < 0.05), and decreased pain scores on postoperative days 3 and 5 (P < 0.05). Supporting previous finding, this study demonstrates ERAS nursing’s effectiveness in promoting intestinal recovery, shortening hospital stays, and accelerating patient recovery[25].

ERAS nursing also significantly improves quality of life. Higher WHOQOL-BREF scores in the ERAS group across all four domains (P < 0.001) demonstrate its positive impact on both physical recovery and mental well-being. The improvement in the environmental domain indicates better adaptation to hospital settings and enhanced comfort during recovery. Environmental care measures (such as quiet management of the ward, air circulation, and adequate lighting) can reduce postoperative anxiety and sleep interruption, thereby indirectly improving gastrointestinal motility and pain perception, which may explain the association between the environmental domain and overall recovery speed observed in this study. Validated in studies of radical gastrectomy (improved gastrointestinal function, fewer complications), ERAS nursing accelerates physical recovery and enhances overall quality of life[26]. With a significantly higher satisfaction rate (95.0% vs 75.0%, P < 0.05), the ERAS group’s positive feedback underscores the effectiveness of ERAS nursing and overall patient satisfaction. This is basically consistent with previous research results.

This single-center retrospective study has limitations. The small sample size of 120 patients may limit the generalizability and reliability of the results. To ensure broader applicability, these findings should be validated in a larger population. The single-center design may introduce selection bias due to differences in nursing practices, patient demographics, and resource availability across hospitals. Future studies should use a multi-center approach to enhance sample diversity and external validity. Additionally, the retrospective nature of the study may affect accuracy due to potential issues with data recording quality. Furthermore, this study used the general WHOQOL-BREF scale, which does not include specific items designed for functional recovery after cholecystectomy (such as dietary tolerance or right upper quadrant discomfort). Future studies could supplement with gallbladder disease-specific quality of life scales (e.g., cholecystectomy outcome score) to obtain more targeted quality of life assessments. Future prospective studies should also include hospitalization costs, resource consumption, and nursing labor costs, using incremental cost-effectiveness ratio to evaluate the economic value of the ERAS model, thereby providing a basis for management decision-making. Consequently, subsequent research should incorporate larger sample sizes and multi-center methodologies to more robustly validate the efficacy of ERAS nursing, thereby establishing a solid foundation for future advancements in this domain.

CONCLUSION

In conclusion, ERAS nursing offers more effective postoperative support for laparoscopic cholecystectomy patients with acute calculous cholecystitis. By improving gastrointestinal recovery, quality of life, and nursing satisfaction, while reducing pain, ERAS provides valuable insights for modern surgical care.