Effects of postoperative quantitative assessment strategy-based nursing in patients with colorectal cancer

Abstract

BACKGROUND

Scientifically sound and reasonable care strategies in surgical nursing play a crucial role in facilitating postoperative recovery and preventing complications. This study focused on the application of quantitative assessment strategies to postoperative care. By quantitatively analyzing the effects of nursing interventions, we explored their feasibility and effectiveness at improving postoperative recovery quality and reducing the incidence of complications. This study provides a scientific basis for nursing practice and offers new insights into nursing management with significant clinical value.

AIM

To analyze the efficacy of postoperative quantitative assessment strategy-based nursing care for patients with colorectal cancer (CRC).

METHODS

This randomized controlled trial evaluated the ability of nursing interventions using a quantitative assessment strategy to prevent postoperative complications and enhance patient recovery. Patients with CRC were randomly divided into routine nursing (RN) and quantitative assessment strategy nursing (QASN) groups. The RN group received standard care, while the QASN group also underwent screenings for visual analog scale for pain, Barthel Index for functional recovery, and self-rating anxiety scale and self-rating depression scale for psychological status. Follow-ups were conducted on postoperative days 1, 7, 14, 28, and 56.

RESULTS

The participants’ baseline characteristics did not significantly differ between study groups, thereby ensuring the reliability of the results. The QASN vs RN group showed significant improvements in pain management (visual analog scale scores) and psychological status (self-rating anxiety scale and self-rating depression scale scores) and a reduced incidence of postoperative complications (P < 0.05). The follow-up evaluations at specified intervals confirmed these findings, indicating that quantitative assessment strategies significantly enhanced patients’ postoperative pain management and psychological well-being.

CONCLUSION

Nursing interventions using structured quantitative assessments demonstrated significantly improved postoperative recovery and quality of life in patients with CRC, supporting their integration into standard postoperative care protocols.

Key Words: Postoperative; Colorectal cancer; Quantitative assessment strategy-based nursing; Patient recovery; Pain management; Nursing evaluation

Core Tip: In this study, we developed individualized interventions based on the patients' actual conditions. By quantitatively assessing the patient’s overall condition, dynamic adjustments were made based on the patient’s change in condition, pain level, and postoperative complications. The study demonstrated that care based on quantitative assessment strategies significantly reduces postoperative complications and improves recovery in patients with colorectal cancer, and the findings support the benefits of combining care plans based on quantitative assessment strategies with standard postoperative care protocols.

INTRODUCTION

Colorectal cancer (CRC), including cancer of the colon and rectum, is a common malignant tumor of the digestive tract. Owing to unhealthy eating habits and lifestyles, the incidence and mortality rates are increasing annually. In 2020, CRC was the third most common cancer worldwide, with approximately 1.93 million new cases[1]. According to a 2022 report from the National Cancer Center of China, CRC ranked second in the number of new cases of malignant tumors and fourth in mortality in China from 2016 to 2022[2]. The pathophysiological mechanisms of CRC involve multiple factors and complex signaling pathways. The main mechanisms include defects in DNA repair pathways, such as mutations in mismatch repair genes or epigenetic silencing, leading to microsatellite instability. Stromal cells in tumor tissues exhibit immunosuppressive and pro-tumorigenic features that upregulate the transforming growth factor-β and wingless-related integration site signaling pathways, network signals that control cell proliferation, survival, differentiation, and apoptosis. Oxidative stress–induced DNA damage is an important factor in the development of CRC.

CRC can be treated using various methods, including surgery, radiotherapy, chemotherapy, and immunotherapy. Comprehensive treatment based on surgical resection is the mainstay of CRC treatment, and the specific surgical method used depends on tumor location, size, and stage as well as overall patient health. However, surgery can negatively impact the patient’s mind and body, leading to reduced quality of life. Pain and postoperative complications, such as adhesions, small bowel obstruction, thrombosis, infections, and anastomotic leakage, can further deteriorate patient health[3,4]. High-quality nursing care is crucial during the postoperative recovery phase in patients with CRC. Effective nursing interventions can reduce postoperative complications, promote recovery, improve therapeutic effects, and improve health-related quality of life[5,6]. Traditional postoperative nursing practices often lack a structured and systematic approach to comprehensively monitoring and evaluating patient rehabilitation, necessitating innovative strategies and quantitative tools to analyze nursing care quality and effectiveness.

Recent advancements in nursing research have highlighted the benefits of integrating quantitative assessment strategies into postoperative care, showing significant potential for enhancing nursing quality. By adopting a system- and data-driven approach, quantitative evaluations in nursing care can objectively and comprehensively assess patient progress, facilitating better clinical decision-making and personalized care plans. Research indicates that these strategies can improve patient monitoring accuracy, enable the early detection of complications, and support the use of evidence-based nursing interventions[7,8]. However, comprehensive research exploring the full potential of these strategies in the postoperative care of patients with CRC is lacking. This study aimed to address this knowledge gap by analyzing the effects of postoperative nursing care based on quantitative assessment strategies in patients with CRC. This study’s innovation lies in its systematic approach to evaluating the impact of structured assessment strategies on patient outcomes. By providing empirical evidence of the benefits of these strategies, this study sought to determine the need to incorporate quantitative assessments into standard nursing care practices for cancer patients.

MATERIALS AND METHODS

Patient selection

One hundred and forty postoperative patients with CRC admitted to our hospital between January 2022 and June 2023 were included. Patients were randomly assigned to the routine nursing (RN) group (n = 72) and the quantitative assessment strategy nursing (QASN) group (n = 68). The RN group received standardized routine postoperative care including nutritional guidance and health education. The QASN group received routine care in addition to the following specialized nursing interventions: (1) Assessments of each patient’s condition and postoperative recovery needs; (2) Regular quantitative comprehensive evaluations administered once weekly to assess postoperative complications, pain, functional recovery, and psychological status; (3) Dynamic adjustment of nursing measures in which nursing plans were adjusted in real time based on the evaluation results to ensure their relevance and efficacy; and (4) Nursing team collaboration, the primary members of which included specialized nurses and registered nurses and secondary members included rehabilitation therapists and psychological counselors. The team worked together to ensure care continuity and comprehensiveness. This study was approved by the hospital ethics committee.

Inclusion and exclusion criteria

The inclusion criteria were as follows: (1) CRC confirmed by imaging and pathological biopsy; (2) Treatment with laparoscopic radical resection in our hospital; (3) Age 18-75 years; (4) No hematologic–immune system disorders; (5) No drug allergies; and (6) Voluntary participation and ability to provide written informed consent.

The exclusion criteria were as follows: (1) Comorbid other tumors or heart failure; (2) Severe organic lesions of the heart, liver, kidney, spleen, or lungs; (3) Cognitive or psychiatric disorders or inability to communicate normally, including memory disorders, aphasia, agnosia, dysarthria, dyspraxia, and visuospatial disorders; (4) Currently pregnant or breastfeeding; (5) Family or personal history of psychiatric disorders; and (6) Poor study adherence, early study withdrawal, or transfer to another hospital.

Study design

This randomized controlled trial evaluated the effectiveness of postoperative nursing care based on a quantitative assessment strategy for patients with CRC. Patients were followed up immediately after surgery, and assessments were performed on postoperative days 1, 7, 14, 28, and 56. The effectiveness of the quantitative assessment strategy was determined by the intergroup comparison of postoperative complications, functional recovery, pain levels, and psychological status (Table 1)[9-11].

Table 1 Nursing interventions based on quantitative evaluation strategies.

Item	Specific operation
Pain assessment	VAS[9]
Functional recovery assessment	Barthel index[10]
Psychological state assessment	SAS; SDS[11]
Complications assessment	Record the occurrence and severity of postoperative complications

VAS: Visual analog scale; SAS: Self-rating anxiety scale; SDS: Self-rating depression scale.

Statistical analysis

All data were collected using an electronic case system through standardized questionnaires that included basic patient information, medical history, postoperative recovery, occurrence of complications, psychological status, and quality of life. Trained professionals conducted data entry to ensure accuracy and completeness. SPSS statistical software (version 25.0) was used for the data analysis. Measurement data are expressed as mean ± SD and were compared between groups using independent sample t-tests. Categorical data are expressed as number of cases (percentage) and were compared between groups using the χ² test or Fisher’s exact test. All statistical analyses were two-sided, with values of P < 0.05 considered statistically significant. A biomedical statistician performed all of the statistical analyses.

RESULTS

Between January 2022 and June 2023, 147 postoperative patients with CRC were evaluated for eligibility. Seven patients were excluded, including four with severe cardiovascular, hepatic, or renal comorbidities; one who died before surgery; and two who were lost to follow-up. The remaining 140 patients were randomly assigned to the QASN (n = 68) or RN (n = 72) group. No perioperative deaths occurred in either group during the follow-up period (56 days). No significant intergroup differences were found in the baseline or surgical characteristics (Table 2).

Table 2 Comparison of general characteristics of the patients, n (%).

Characteristic	QASN group (n = 68)	RN group (n = 72)	P value
Age (year), mean ± SD	60.10 ± 9.60	59.67 ± 8.89	0.947
BMI (kg/m²), mean ± SD	24.75 ± 3.94	25.50 ± 3.69	0.777
Gender	-	-	0.247
Male	35 (51.9)	29 (40.0)	-
Female	33 (48.1)	43 (60.0)	-
Disease type	-	-	0.518
Colon cancer	35 (51.9)	42 (57.8)	-
Rectal cancer	33 (48.1)	30 (42.2)	-
TNM staging	-	-	0.319
Phase I	25 (36.5)	18 (24.4)	-
Phase II	22 (32.7)	27 (37.8)	-
Phase III	21 (30.8)	27 (37.8)	-
Educational level	-	-	0.507
College degree or above	33 (48.5)	29 (40.0)	-
High school/vocational	22 (32.3)	24 (33.3)	-
Junior high school or below	13 (19.2)	19 (26.7)	-
Complications	-	-	0.471
Hypertension	21 (30.8)	29 (40.0)	-
Type 2 diabetes	25 (36.5)	21 (28.9)	-
Lacunar cerebral infarction	16 (23.1)	16 (22.2)	-
Hypothyroidism	6 (9.6)	6 (8.9)	-
Dukes stage	-	-	0.867
A	17 (25.0)	14 (20.0)	-
B	27 (40.4)	29 (40.0)	-
C	16 (23.1)	19 (26.7)	-
D	8 (11.5)	10 (13.3)	-

QASN: Quantitative assessment strategy nursing; RN: Routine nursing; BMI: Body mass index; TNM: Tumor node metastasis.

Postoperative complications

Postoperative complications of CRC can significantly affect a patient’s physical and psychological recovery, length of hospitalization, and overall prognosis. We compared the incidence of postoperative complications between the QASN and RN groups (Table 3). The complications analyzed included wound infection, pulmonary infection, intestinal obstruction, anastomotic leakage, urinary retention, urinary tract infection, postoperative bleeding, deep vein thrombosis, and malnutrition. Complications that did not occur were excluded from the statistical analysis. Five (7.35%) and 14 (19.44%) complications occurred in the QASN and RN groups, respectively. One patient in the RN group developed pulmonary infections and surgical site infections. Fisher’s exact test showed that the overall complication rate was significantly lower in the QASN vs RN group (P < 0.05).

Table 3 Comparison of postoperative complication rates between the two groups, n (%).

Complication	QASN group (n = 68)	RN group (n = 72)	P value
Incision infection	2 (2.94)	3 (4.17)	-
Pulmonary infection	0 (0.00)	2 (2.78)	-
Intestinal obstruction	1 (1.47)	1 (1.39)	-
Anastomotic fistula	1 (1.47)	1 (1.39)	-
Uroschesis	0 (0.00)	2 (2.78)	-
Urinary tract infection	1 (1.47)	1 (1.39)	-
Postoperative bleeding	0 (0.00)	1(1.39)	-
Deep vein thrombosis	0 (0.00)	1 (1.39)	-
Malnutrition	0 (0.00)	2 (2.78)	-
Total	5 (7.35)	14 (19.44)	0.041

QASN: Quantitative assessment strategy nursing; RN: Routine nursing.

Functional recovery and pain relief

Pain is often accompanied by discomfort and distressing emotions, which can drain a patient’s energy and reduce their recovery motivation. Pain can also limit a patient’s mobility, leading to functional impairment and muscle atrophy. Relevant data were collected to compare functional recovery and pain relief at different pre- and postoperative time points (Table 4). Preoperatively, no significant intergroup differences were found between the QASN and RN groups in Barthel index (68 ± 10 vs 68 ± 9) and visual analog scale (VAS) score (3.1 ± 1 vs 3.0 ± 0.8), respectively (P > 0.05). On postoperative day 1, a significant decrease in Barthel index (40 ± 7 in both groups) and increase in VAS scores (6.8 ± 1 vs 7.0 ± 1.1 in QASN and RN group, respectively). On postoperative day 7, the mean Barthel index was significantly higher in the QASN group (52 ± 8 vs 45 ± 9, P < 0.05), while the mean VAS score was lower (5.7 ± 0.8 vs 5.8 ± 1, P > 0.05). The differences increased on postoperative days 14, 28, and 56, with the QASN group showing higher Barthel indices and lower VAS scores at each time point (all P < 0.05). These results showed that pain management in the QASN group minimized pain, reduced postoperative complications, facilitated early mobility and functional recovery, shortened the length of hospital stay, reduced medical costs, and improved patient satisfaction.

Table 4 Comparison of functional recovery and pain level between the two groups of patients, mean ± SD.

Item	Classification	Preoperative	Postoperative
			1 day	7 days	14 days	28 days	56 days
BI	QASN group (n = 68)	68 ± 10	40 ± 7	52 ± 8	61 ± 10	75 ± 12	80 ± 13
	RN group (n = 72)	68 ± 9	40 ± 8	45 ± 9	52 ± 9	65 ± 10	70 ± 11
	P value	0.999	0.999	0.371	0.039	0.013	0.009
VAS	QASN group (n = 68)	3.1 ± 1	6.8 ± 1	5.7 ± 0.8	4.5 ± 0.8	3.5 ± 0.7	2.5 ± 0.5
	RN group (n = 72)	3.0 ± 0.8	7.0 ± 1.1	5.8 ± 1	5.5 ± 0.9	5.0 ± 0.8	4.5 ± 0.7
	P value	0.899	0.827	0.899	0.015	0.007	0.001

BI: Barthel Index; VAS: Visual analog scale; QASN: Quantitative assessment strategy nursing; RN: Routine nursing.

Psychological status

The effectiveness of the nursing intervention was further confirmed by the postoperative self-rating anxiety scale (SAS) and self-rating depression scale (SDS) scores (Table 5). The preoperative SAS and SDS scores did not significantly differ between groups (P > 0.05), indicating comparable preoperative anxiety and depression. However, on postoperative day 56, the SAS and SDS scores were significantly lower in the QASN vs RN group (P < 0.05). These findings suggest that the patients’ anxiety and depression status improved significantly more in the QASN vs RN group.

Table 5 Comparison of postoperative psychological assessment between the two groups.

Classification	Item	Preoperative	Postoperative
QASN Group (n = 68)	SAS	55.3 ± 10.2	34.2 ± 7.5
RN Group (n = 72)		54.7 ± 9.8	42.6 ± 8.1
P value		0.945	0.021
QASN Group (n = 68)	SDS	60.1 ± 11.5	38.1 ± 8.4
RN Group (n = 72)		59.4 ± 10.9	45.3 ± 8.9
P value		0.938	0.019

QASN: Quantitative assessment strategy nursing; SAS: Self-rating anxiety scale; RN: Routine nursing; SDS: Self-rating depression scale.

DISCUSSION

Nursing care based on quantitative assessment strategies involves systematic numerical measurements and analyses that evaluate patient care quality and outcomes. This study demonstrated that the implementation of a quantitative assessment-based nursing intervention significantly improved postoperative outcomes in patients with CRC. Continuous follow-up provided in this study during the patients’ postoperative recovery allowed for the timely modification and optimization of the nursing care plan, thereby enhancing both outcomes and patient satisfaction. Patients in the QASN group showed lower complication rates, better pain management, improved functional recovery, enhanced mental health, and a higher quality of life than those in the RN group.

There is an increasing trend toward younger patients with CRC, and it remains more prevalent in elderly patients. Studies have shown that the incidence and severity of comorbidities directly affect patient prognosis and survival rates[12]. The involvement of professional nursing care teams including doctors, specialized nurses, and rehabilitation professionals significantly improves patient prognosis and reduces early postoperative mortality rates[13]. Our findings also indicated that nursing interventions using quantitative evaluation strategies can reduce the incidence of postoperative complications in patients with CRC. The data showed that patients in the QASN group experienced fewer postoperative complications than those in the RN group. Specifically, the incidence of complications such as wound infection, pulmonary infection, and postoperative bleeding was lower in the QASN group, highlighting the potential benefits of implementing quantitative assessment strategies in postoperative care. This improvement may be attributed to strengthened monitoring and early interventions for postoperative complications as well as personalized care plans that include early mobilization, respiratory exercises, efficient nutrition programs, and physical intensity exercises.

Therefore, effective pain management is crucial to a patient’s postoperative recovery[14]. Here we assessed the VAS scores of the patients at various postoperative follow-up time points. If a patient’s pain score consistently remains high, adjustments to the painkiller type and dosage as well as the addition of non-pharmacological pain management measures (such as cold compresses, hot compresses, and physical therapy) can be considered. Our findings indicate that the use of standardized pain assessment protocols in the QASN group can more effectively control pain, underscoring the role of quantitative assessments in optimizing pain management strategies.

The postoperative psychological state of patients with CRC is a significant factor affecting their postoperative rehabilitation and quality of life[15]. Scientific and reasonable nursing interventions can markedly improve patients’ psychological states and enhance postoperative rehabilitation outcomes[16]. The results showed that the SAS and SDS scores were significantly lower in the QASN vs RN group (P < 0.05). This suggests that the nursing intervention of the QASN group effectively alleviated the patients’ anxiety and depression by providing more targeted nursing measures and psychological intervention techniques, such as relaxation training and psychological counseling[17]. In addition, the nurses in the QASN group were trained to have higher psychological care skills and able to provide higher-quality psychological care and social support to improve patients’ psychological status[18].

In previous studies, the concept of nursing interventions was vague, assessment process subjective and arbitrary, and operation weak; therefore, it was impossible to provide graded care for each patient’s overall condition[19,20]. In this study, we developed personalized interventions based on patients’ actual conditions. By quantitatively assessing the patients’ overall conditions and grading their nursing risks, we formulated more targeted and graded nursing interventions that were dynamically adjusted according to their changing conditions, pain level, and postoperative complications to promote their early mobility and functional recovery. The use of mathematical methods to quantify the results of evaluation components has high objectivity and reliability, which supports the incorporation of quantitative assessment strategies by standard postoperative care providers. However, the single-center design and relatively small sample size limited the generalizability of our findings. Additionally, the choice of quantitative assessment tools may have affected our results. Larger multicenter studies are needed to validate our findings and explore the long-term impact of such interventions.

CONCLUSION

Nursing interventions based on structured quantitative assessments have significantly improved the postoperative recovery and quality of life of patients with CRC. These findings support the use of these strategies in routine clinical practice to enhance patient care quality and outcomes.