Perioperative multidisciplinary nursing model for endoscopic gastric submucosal dissection development and effect evaluation

Abstract

BACKGROUND

Endoscopic submucosal dissection (ESD) has become the standard endoscopic treatment for early gastric cancer (EGC), offering high en bloc resection and curative resection rates. However, despite its minimally invasive nature, ESD is still associated with potential complications such as bleeding, perforation, and delayed recovery, which can prolong hospital stays and affect patient outcomes. While advancements in digestive endoscopy have improved procedural precision and safety, perioperative care remains a critical factor influencing recovery. Conventional nursing models often lack coordination across specialties and fail to address the comprehensive needs of EGC patients undergoing ESD. In contrast, multidisciplinary team (MDT) approaches have demonstrated efficacy in improving care quality and patient satisfaction in oncology settings. Yet, the application and effectiveness of a structured perioperative MDT nursing model specifically tailored for ESD patients with EGC have not been fully explored. Therefore, developing and validating an evidence-based MDT nursing protocol is essential to optimize perioperative management and enhance clinical outcomes in this patient population.

AIM

To construct ESD for patients with EGC assisted by digestive endoscopy, the perioperative MDT nursing model for ESD treatment was adopted, and its effect was evaluated.

METHODS

A total of 99 patients diagnosed with EGC in our hospital from April 2022 to April 2025 were prospectively selected as the observation group research subjects to receive the MDT nursing mode. Another 99 patients were selected in a 1:1 ratio as the control group to receive the conventional nursing mode. Both groups received ESD treatment. The recovery of intestinal rumbling sounds after surgery, the time of first getting out of bed for activities, the average length of hospital stay, and the satisfaction situation were compared between the two groups.

RESULTS

Intergroup comparisons revealed that the observation group patients had significantly better outcomes in terms of time to bowel sound recovery (12.53 ± 1.21) hours, first time out of bed activity (23.53 ± 2.34) hours, length of hospital stay (6.63 ± 0.46) days, and overall complication rate (3.03%), along with a significantly higher satisfaction rate of 100% compared to 80.81% in the control group (P < 0.05).

CONCLUSION

MDT can significantly promote the recovery of EGC patients after ESD treatment assisted by digestive endoscopy, improve the treatment effect of patients, and increase patient satisfaction. It is worthy of clinical promotion and application.

Key Words: Digestive endoscopy; Endoscopic submucosal dissection; Early gastric cancer; Multidisciplinary collaborative nursing; Clinical effect

Core Tip: This study constructed a perioperative multidisciplinary team (MDT) nursing model for patients with early gastric cancer undergoing digestive endoscopy-assisted endoscopic submucosal dissection. Compared to conventional care, the MDT model significantly shortened postoperative bowel sound recovery time, first ambulation time, and hospital stay, while achieving a 100% patient satisfaction rate. The findings demonstrate that the MDT approach optimizes recovery outcomes and enhances the quality of nursing care for early gastric cancer patients, warranting clinical promotion.

INTRODUCTION

Gastric cancer (GC) is a common malignant tumor of the digestive tract. Epidemiological data show[1] that the incidence and mortality rates are significantly higher in men, with 15.8 new cases and 11 deaths per 100000 people annually, compared to 7.0 new cases and 4.9 deaths per 100000 women each year. Currently, 50% to 70% of early GC (EGC) patients can be diagnosed directly. Data indicate[2] that EGC accounts for 50% of all GC cases, with a five-year survival rate of up to 90%, significantly better than that of advanced GC. Endoscopic submucosal dissection (ESD) is the primary treatment for EGC patients[3]. Traditional ESD, due to its single-arm operation and limitations in vertical movement, leads to inadequate precision control of the instrument tip during surgery, resulting in postoperative bleeding in 4.1% to 8.5% of patients[4], which affects treatment outcomes. Therefore, finding assistive technologies is crucial for improving the efficacy of ESD and enhancing the prognosis of EGC patients. With advancements in medical technology, the clinical application of digestive endoscopy in ESD has significantly improved the recognition of submucosal layers, providing surgeons with a broader field of view and more surgical operation during surgery, thereby reducing patient trauma and postoperative complications. However, a standardized comprehensive perioperative nursing protocol for ESD assisted by digestive endoscopy has not yet been established in clinical practice[5]. With the development of precision nursing models, the multidisciplinary team (MDT) nursing model has demonstrated significant advantages in the field of oncology. Ma et al[6] found that among 100 pancreatic cancer patients who underwent MDT, the postoperative complication rate decreased to 8.00%, and satisfaction was as high as 94.00%, suggesting that MDT can optimize patient prognosis. However, few studies have explored the impact of perioperative MDT on the clinical outcomes and nursing experience of EGC patients undergoing ESD assisted by digestive endoscopy. Based on this, this study applies perioperative MDT to EGC patients to observe its effects on the incidence of postoperative complications, recovery indicators, and patient satisfaction, and analyzes the feasibility of promoting this model, providing a theoretical basis for optimizing perioperative nursing strategies for EGC patients in clinical practice.

MATERIALS AND METHODS

Data and methods

General information: A total of 99 patients diagnosed with EGC in our hospital from April 2022 to April 2025 were prospectively selected as the observation group, and another 99 patients were included in the control group at a 1:1 ratio. No significant differences were observed in the general characteristics between the two groups, as shown in Table 1. Based on the Gastric Cancer Diagnosis and Treatment Guidelines[7], pathological diagnosis was defined as a malignant tumor invading only the gastric mucosal layer or submucosa, regardless of lymph node metastasis or tumor size.

Table 1 Comparison of general information between the two groups, n (%).

Group		Control group (n = 99)	Observation group (n = 99)	t	P value
Gender	Male	53 (53.54)	51 (51.53)	0.081	0.775
	Female	46 (46.46)	48 (48.48)
Age (mean ± SD, years)		61.75 ± 9.82	61.10 ± 9.16	0.451	0.63
Place of residence	Countryside	52 (52.53)	51 (51.52)	0.02	0.887
	Town	47 (47.47)	48 (48.48)
Educational level	Primary school and below	55 (55.56)	53 (53.54)	0.233	0.972
	Junior high school	22 (22.22)	24 (24.24)
	High school	15 (15.15)	16 (16.16)
	College degree or above	7 (7.07)	6 (6.06)
Coronary heart disease or diabetes	Yes	36 (36.36)	33 (33.33)	0.2	0.654
	None	63 (63.64)	66 (66.67)
Pathological staging of the disease	I	33 (33.33)	31 (31.31)	1.173	0.756
	II	18 (18.18)	21 (21.21)
	III	33 (33.33)	28 (28.28)
	IV	15 (15.15)	19 (19.19)
BMI (mean ± SD, kg/m2)		20.57 ± 1.23	20.34 ± 1.89	1.014	0.311
PG-SGA score (mean ± SD, points)		10.45 ± 3.67	10.78 ± 3.12	0.681	0.496

BMI: Body mass index; PG-SGA: The Scored Patient Generated Subjective Global Assessment.

Inclusion criteria: Meeting the diagnostic criteria for EGC[7]; meeting the indications for ESD[8]: (1) Tumor infiltration limited to the mucosal layer (Tis or T1a); (2) Histologically assessed as differentiated GC, with no size restriction if non-ulcerative, or tumor diameter ≤ 3 cm if ulcerated; and (3) Histologically assessed as undifferentiated GC, which must be non-ulcerative and have a tumor diameter ≤ 2 cm.

Exclusion criteria: (1) Presence of other malignant tumors; (2) Previous radical treatments such as radiotherapy or chemotherapy; (3) Preoperative evidence of distant tumor metastasis, involvement of adjacent organs, or signs of tumor recurrence; (4) Severe impairment of liver or kidney function, or inadequate function of vital organs rendering the patient unable to tolerate surgery; and (5) Surgical procedures performed under emergency conditions.

Perioperative MDT construction for ESD treatment of EGC assisted by digestive endoscopy

Literature search selection criteria: First, literature retrieval strategy: The search keywords include: EGC, endoscopic mucosal dissection, digestive endoscopy-assisted ESD, emergency rescue room, nursing quality, and nursing evaluation. Search English databases such as PubMed, EMBASE, Ovid, etc. Literature screening criteria: (1) Exclude literature with similar or duplicated content; (2) Exclude non Chinese or English literature; (3) Exclude literature that cannot be obtained in full or read; (4) Exclude conference abstracts, case studies, and other types of literature; and (5) Exclude literature with a quality rating of C. Literature quality assessment[9]: It includes 6 criteria, each corresponding to 4 evaluation result options: Compliant, non compliant, applicable and not applicable. When the content of the literature is completely consistent with the criteria description, it indicates that the risk of bias is at its lowest level, which is Class A; if the content of the literature partially meets the criteria and the risk of bias is moderate, it will be classified as level B; if it is completely inconsistent and has a high risk of bias, it is classified as level C. Second, extraction of evaluation indicators: The research team used a self-designed literature information extraction table to collect relevant data, including literature titles, types, publication years, research recommendations, and quality assessment conclusions. Two researchers independently extracted information and then cross-checked it with each other. For any inconsistencies, consensus was reached through discussion. This study conducted a descriptive analysis of the literature, selecting indicators from three dimensions: “close correlation, nursing characteristics, and operational feasibility”, and classifying and organizing these indicators based on the “structure process outcome” ternary framework.

Compilation of inquiry questionnaire: The research team designed the first round of the inquiry questionnaire through collective discussion, which consists of three main parts. The specific content is as follows: (1) Introduction: Including acknowledgements, research objectives, research scope, and guidelines for filling out; (2) Expert background investigation: Basic information of the expert, level of understanding of the content, and evaluation criteria. Basic information includes age, educational background, professional title, work experience, etc. According to the level of understanding of the content, it is divided into five levels, with corresponding scores ranging from 1 to 5. The evaluation criteria include intuitive judgment, theoretical reasoning, practical experience, and literature review, and are divided into three levels based on the degree of influence of expert evaluation: High, medium, and low; and (3) Questionnaire subject: It includes 3 primary indicators, 17 secondary indicators, and 42 tertiary indicators. According to the importance of the indicators, they are divided into five levels, ranging from 1 to 5 points, for experts to provide additional opinions and suggestions.

Selection of inquiry experts: In this study, experts participating in the inquiry were selected based on strict criteria, as follows: (1) Experts must have work experience in multidisciplinary nursing management, nursing education, and related fields; (2) Having worked in the aforementioned fields for over 10 years; (3) Holding a vice senior or higher professional title; (4) Having a bachelor’s degree or higher; and (5) Have a good understanding of the research project and have a high enthusiasm for the research content. Based on this, a total of 16 experts were selected to participate in the inquiry.

Inquiry implementation process: After discussion by the research team, considering convenience, email was chosen as the method of sending the questionnaire. The researchers sent an electronic questionnaire to the experts’ email through a dedicated email and notified them by phone to download the questionnaire. They also communicated that the questionnaire should be completed and returned within one week. On the fifth natural day after the questionnaire was distributed, the researchers checked the received questionnaires in the email and reminded experts who had not returned the questionnaires to submit them on time. After all questionnaires have been successfully collected, they will be organized in an orderly manner, and the scoring results will be statistically analyzed. And summarize the feedback from experts. Researchers add, delete, or modify indicators based on expert feedback and develop the next round of questionnaires accordingly. When the opinions of the experts are basically consistent, end the questionnaire survey. In this study, after two rounds of questionnaire surveys, the opinions of experts reached a consensus.

Perioperative MDT procedure for ESD treatment of EGC assisted by digestive endoscopy

Treatment methods: Using a high-definition electronic gastroscope (Olympus, CV-290 model, Japan) system to determine the exact location of the lesion, and using a high-frequency electric knife (VIO300D model, Germany) to mark around the lesion. Inject a small amount of glycerol fructose solution into multiple points in the submucosal layer of the marked area until the mucosa is locally raised and separated from the muscle layer. Then, use the Olympus KD-650 L along the marked points. High frequency electric knife is used to cut open the mucosa and peel off the diseased tissue in the submucosal layer. During the surgical operation, pay attention to the precise control of bleeding and avoid vigorous pulling movements to the greatest extent possible. After the tissue dissection is completed, electrocoagulation should be performed on the exposed blood vessels in a timely manner. If there is a large-scale bleeding situation during the surgery, epinephrine should be sprayed immediately, and hemostatic clips should be used for emergency hemostasis. After confirming that there are no adverse conditions such as active bleeding or perforation in the surgical area, the specimen can be safely removed, and the endoscope can be exited in an orderly manner. Postoperative patients need to fast for 48 hours, receive acid suppressants, and use antibiotics appropriately according to the situation. Continuously monitor the patient’s vital signs and take targeted measures immediately upon detecting potential complications. On the premise of the patient’s physical condition gradually improving, according to the principle of gradual progress, a liquid diet is given first, and after the patient adapts, they transition to a semi-liquid diet, ultimately returning to a normal eating state.

Perioperative MDT method: Control group: Receiving standard care, nursing content: Observing the condition, assisting the physician in completing surgery, changing medication according to medical advice, providing health education, dietary advice, and other routine nursing measures. Observation group: Receive MDT collaborative care based on the control group. (1) Establish a multidisciplinary nursing team consisting of nurses specializing in digestive endoscopy and surgical personnel specializing in gastrointestinal tumors. The team includes 5 gastrointestinal oncology nurses (responsible for evaluation and basic nursing), 3 coordinating nurses (data collection and cross-disciplinary communication), 4 digestive endoscopy nurses (intraoperative cooperation and postoperative nursing), 1 attending physician (providing treatment advice), and 1 head nurse of gastrointestinal oncology surgery (assisting with tasks). Members must undergo unified training and pass the assessment before taking up their posts; (2) A core MDT initiation meeting is held within 24 hours of each patient’s admission. Regular assessment meetings are then conducted on the 1st and 3rd postoperative days, followed by a summary meeting prior to discharge. An encrypted WeChat group is established for daily patient condition updates, sharing test results, and coordinating simple issues. For emergencies, direct phone calls are made to the relevant responsible personnel. All nursing assessments, executed medical orders, and patient feedback are recorded in real-time in the hospital information system, ensuring synchronized information for all team members; (3) Admission nursing process: Gastrointestinal oncology nurses receive patients, collect their medical history, establish nursing records, and synchronize information through WeChat groups and phone calls. Doctors and nurses conduct preliminary assessments and develop treatment plans (ESD). After identifying nursing risks, nurses collaborate with other departments to develop nursing plans. Digestive endoscopy nurses provide health education to patients and their families (explaining GC knowledge with pictures and text), helping them adapt to the environment and relieve psychological pressure; (4) Preoperative care (from the 2^nd day to before surgery): Gastrointestinal oncology nurses conduct ward rounds from 8:00 to 12:00 every day, follow the nursing plan, and guide preoperative diet (avoid spicy stimulation, provide food charts to choose a balanced diet). Monitor the patient’s emotions and use music therapy or psychological counseling. Based on symptom feedback, collaborate with doctors to adjust the plan. Preoperative preparation includes fasting for 8 hours and water deprivation for 2 hours; (5) Intraoperative cooperation: Under the guidance of the physician, the digestive endoscopy nurse accurately and timely cooperates with the physician to arrange the patient’s position, prepare materials, closely cooperate with the operation, and submit tissue specimens for examination; (6) Postoperative care measures: Postoperative care measures: Digestive endoscopy nurses conduct regular inspections, monitor patients’ vital signs, and report to the head nurse. The head nurse collaborates with multiple departments to optimize postoperative nursing plans, including wound care (explaining the role of moist dressings) and psychological support (suggesting that family members accompany for 1 hour a day and strengthen communication). For fasting patients, collaborate with nutritionists to develop an intravenous nutrition plan; personalize meal preparation after resuming diet. During the rehabilitation stage, the coordinating nurse contacts the rehabilitation department to develop an exercise plan based on the patient’s condition, and the gastrointestinal oncology nurse guides the exercise; (7) Postoperative emergency plan: When monitoring detects hematemesis, melena, or a significant drop in hemoglobin levels, the endoscopy nurse immediately reports to the attending physician and the director of the endoscopy center, and prepares for an emergency endoscopic hemostasis procedure. If the patient experiences severe abdominal pain, abdominal muscle rigidity, or an upright abdominal X-ray suggests subdiaphragmatic free air, the nurse immediately contacts the surgery department for a consultation and coordinates operating room preparation. In cases of a persistent temperature > 38.5 °C or a significant rise in procalcitonin levels, the responsible nurse immediately reports to the physician and contacts the pharmacy department for antibiotic therapy guidance; and (8) Nursing work on the day of discharge: Nurses and coordinating nurses in the gastrointestinal oncology department will refer to nursing records to verify the implementation of all nursing measures and unfinished tasks. After that, professional nurses will provide personalized health guidance to patients again. The multidisciplinary collaborative nursing team will work together to complete the patient’s discharge summary form and provide a detailed list of relevant precautions to be taken after discharge. The flowchart detailing the specific intervention implementation is shown in Figure 1.

Figure 1 Flowchart of intervention measures in the observation group. MDT: Multidisciplinary team.

Evaluation indicators

Objective indicators: According to the hospital medical record system, the recovery time of postoperative bowel sounds, the first time of getting out of bed activity, and the average length of hospital stay were collected for two groups of research subjects.

Satisfaction survey: Research on evaluating nursing satisfaction through self-made measurements. After evaluation, the Cronbach’s alpha coefficient of the scale reached 0.91, indicating high reliability and validity. The scale adopts a multidimensional evaluation architecture, consisting of 6 dimensions, each with 5 sub-items, for a total of 30 items. Divide the evaluation results into four levels: Satisfied, somewhat satisfied, average, and dissatisfied. After the intervention phase, conduct a satisfaction questionnaire survey and statistics.

Statistical analysis

The participation enthusiasm of experts is reflected in the proportion of valid questionnaires collected. The data analysis was conducted using SPSS 27.0 software, and the Analytic Hierarchy Process was used to determine the weights of each indicator. The calculation of indicator weights is carried out using the Yaanalytic Hierarchy Process V0.6.0 software to construct a hierarchical structure model. Measurement data, results (mean ± SD) represent inter-group comparison t-test; count data, display results in proportion, and compare between groups using a χ² test. Using P < 0.05 as the testing criterion.

RESULTS

Consultation with experts for general information

This study selected 16 experts to participate in the inquiry, including 3 males and 13 females; age ≤ 40 years old, 41-50 years old, 51-55 years old, 5, 7, and 4 cases respectively; 12 cases with bachelor’s and master’s degrees; 5 cases of intermediate professional title, 7 cases of deputy senior title, and 4 cases of senior professional title; work experience of 8-14 years, 15-20 years, ≥ 21 years, 5, 6, 5 cases; professional directions include clinical nursing, nursing management, nursing research, and medical care for 5, 6, 2, and 3 cases.

Expert enthusiasm and authority level

This study used the Delphi expert inquiry method to collect professional opinions from two rounds of experts. During each round of inquiry, questionnaires were distributed to 16 experts, and both rounds of questionnaires achieved 100% effective responses. The experts have a high willingness and enthusiasm to participate in this study. The authoritative evaluation of experts adopts Cr as a quantitative evaluation, consisting of two dimensions: Expert familiarity (Cs) and judgment basis (Ca). The calculation formula is Cr = (Ca + Cs)/2, and the results are shown in Table 2.

Table 2 Expert authority level table.

Round	Cs	Ca	Cr
Round one	0.803	0.712	0.758
The second round	0.903	0.753	0.828

Concentration of expert opinions

This study reflects the concentration of expert opinions through the ratio of the indicator importance score to the full score. The results of the second round of inquiry showed that the importance scores of each indicator were between 4.25 points and 5.00 points, and the full score ratio reached or exceeded 53.6%, indicating that experts generally recognize and attach great importance to these indicators.

Coordination level of expert opinions

In this study, the Kendall’s W coefficient was used to evaluate the degree of coordination among expert opinions, with values ranging from 0 to 1. During the two rounds of expert inquiry in this study, the Kendall harmony coefficients obtained were 0.416 and 0.439, respectively. Through comparative analysis, it can be seen that the coordination of expert opinions in the second round of expert inquiry showed an improvement trend compared to the first round, and there was a statistical difference (P < 0.05).

Index coefficient of variation

In this study, the coefficient of variation is used to measure the degree of dispersion of experts’ opinions on a certain indicator. The calculation method for the coefficient of variation is the ratio of s to. The results of the second round of expert inquiries showed that the coefficient of variation for the primary indicators ranged from 0.00 to 0.12, for the secondary indicators from 0.00 to 0.23, and for the tertiary indicators from 0.04 to 0.19. This indicates that there are differences in the volatility of expert opinions among different levels of indicators, with the first level indicator having the most concentrated expert opinions, while the third level indicator has relatively greater volatility.

Inquiry results of perioperative MDT evaluation index system for EGC patients

Table 3 shows the inquiry results of the MDT nursing quality index system for EGC patients during the perioperative period.

Table 3 Inquiry results of the multidisciplinary team nursing quality index system for early gastric cancer patients during the perioperative period.

Indicator	Importance (mean ± SD, points)	Coefficient of variation	Weight
1 Structural indicators	4.50 ± 0.55	0.12	0.1200
1.1 Human resource allocation	4.70 ± 0.45	0.10	0.0900
1.1.1 Nurse-to-patient ratio	4.60 ± 0.40	0.08	0.0080
1.1.2 Nurse skill level composition ratio	4.75 ± 0.30	0.06	0.0070
1.1.3 Presence of a multidisciplinary enhanced recovery after surgery (ERAS) team	4.90 ± 0.25	0.05	0.0120
1.1.4 Average nursing hours per 24 hours per hospitalized patient	4.70 ± 0.50	0.10	0.0030
1.2 Skill level and concept	4.75 ± 0.35	0.07	0.1100
1.2.1 Pass rate of nurse specialist skill training and assessment	4.85 ± 0.25	0.05	0.0230
1.2.2 Implementation rate of nurse training on ERAS concepts	4.80 ± 0.30	0.06	0.0230
1.3 Nursing protocols and procedures	4.70 ± 0.35	0.07	0.1200
1.3.1 Pass rate of training on perioperative gastric cancer nursing protocols	4.85 ± 0.25	0.05	0.0230
1.3.2 Pass rate of training on nasoenteric tube care protocols	4.80 ± 0.30	0.06	0.0070
1.3.3 Pass rate of training on abdominal drainage tube care protocols	4.75 ± 0.25	0.05	0.0070
1.3.4 Pass Rate of training on venous catheter maintenance procedures	4.70 ± 0.30	0.06	0.0070
1.4 Equipment	4.41 ± 0.25	0.13	0.0894
1.4.1 Ratio of monitors, mobile IV stands, walkers to beds	4.63 ± 0.25	0.14	0.0157
2 Process indicators	6.00	0.00	0.7332
2.1 Health education	4.65 ± 0.40	0.09	0.0690
2.1.1 Implementation rate of perioperative education on significance and methods of early postoperative ambulation	4.70 ± 0.40	0.09	0.0070
2.1.2 Mastery rate of postoperative oral nutritional solution preparation methods	4.60 ± 0.50	0.11	0.0030
2.1.3 Mastery rate of preoperative lung function exercise methods (for patients with underlying pulmonary diseases)	4.75 ± 0.35	0.07	0.0160
2.1.4 Implementation rate of discharge guidance	4.70 ± 0.40	0.09	0.0150
2.2 Psychological care	4.20 ± 0.60	0.14	0.0290
2.2.1 Screening rate for perioperative anxiety and depression	4.65 ± 0.650	0.11	0.0090
2.2.2 Intervention rate for perioperative anxiety and depression	4.60 ± 0.55	0.12	0.0060
2.3 Intraoperative temperature managemen	4.75 ± 0.35	0.07	0.1003
2.3.1 Implementation rate of intraoperative temperature management measures	4.85 ± 0.25	0.05	0.0402
2.3.2 Intraoperative normothermia achievement rate	4.80 ± 0.30	0.06	0.0402
2.4 Cooperation in tumor-free protective isolation techniques	6.00	0.00	0.3958
2.4.1 Implementation rate of supervision and cooperation in tumor-free protective isolation techniques	6.00	0.00	0.3958
2.5 Venous thromboembolism (VTE) management	4.65 ± 0.50	0.11	0.0440
2.5.1 VTE assessment rate	4.70 ± 0.40	0.09	0.0130
2.5.2 Implementation rate of VTE preventive measures	4.65 ± 0.45	0.10	0.0130
2.6 Pain management	4.55 ± 0.60	0.13	0.0320
2.6.1 Postoperative pain assessment rate	4.75 ± 0.35	0.07	0.0082
2.6.2 Mastery rate of patient- or family-controlled intravenous analgesia pump knowledge	4.60 ± 0.40	0.09	0.0020
2.6.3 Implementation rate of multimodal analgesia	4.70 ± 0.35	0.07	0.0082
2.7 Nutrition management	4.85 ± 0.25	0.05	0.2060
2.7.1 Preoperative nutrition assessment rate	4.80 ± 0.35	0.06	0.0252
2.7.2 Preoperative nutrition intervention rate	4.87 ± 0.35	0.07	0.0252
2.7.3 Implementation rate of postoperative early ONS1	4.93 ± 0.26	0.05	0.0772
2.8 Tube management	4.82 ± 0.35	0.07	0.1057
2.8.1 Venous catheter care compliance rate	4.82 ± 0.35	0.07	0.0182
2.8.2 Nasoenteric tube care compliance rate	4.75 ± 0.35	0.07	0.0200
2.8.3 Abdominal drainage tube care compliance rate	4.75 ± 0.35	0.07	0.0200
2.8.4 Implementation rate of urinary catheter removal on postoperative day 1 (for clinically stable patients)	4.55 ± 0.50	0.11	0.0070
2.9 Early ambulation	4.65 ± 0.59	0.09	0.0692
2.9.1 Completion rate of bedside activities on the day of surgery	4.75 ± 0.52	0.09	0.0216
2.9.2 Completion rate of ambulation on postoperative day 1	4.75 ± 0.35	0.09	0.0216
3 Outcome indicators	4.73 ± 0.46	0.07	0.2395
3.1 Adverse events	4.75 ± 0.35	0.09	0.2825
3.1.1 Incidence of stage 2 or above pressure injuries in hospitalized patients	4.80 ± 0.41	0.09	0.0117
3.1.2 Incidence of central venous catheter (CVC)-related bloodstream infections	4.87 ± 0.35	0.07	0.0187
3.1.3 Incidence of falls in hospitalized patients	4.73 ± 0.59	0.13	0.0041
3.1.4 Proportion of fall-related injuries in hospitalized patients	4.80 ± 0.56	0.12	0.0104
3.1.5 Incidence of deep vein thrombosis	4.84 ± 0.35	0.07	0.0166
3.1.6 Unplanned extubation rate	4.83 ± 0.56	0.12	0.0060
3.2 Complications	4.87 ± 0.35	0.07	0.4732
3.2.1 Incidence of aspiration during anesthesia recovery	4.84 ± 0.35	0.07	0.0852
3.2.2 Unplanned tube occlusion rate	4.83 ± 0.56	0.12	0.0281
3.3 Bowel function recovery	4.70 ± 0.45	0.10	0.1223
3.3.1 Bowel sound recovery rate within 12-24 hours postoperatively	4.87 ± 0.25	0.05	0.0291
3.4 Length of stay	4.70 ± 0.45	0.10	0.1223
3.4.1 Average length of stay for discharged patients	4.87 ± 0.26	0.05	0.0291

¹Oral nutritional supplements refer to the supplementation of deficiencies in the daily diet through the oral intake of special medical use (formula) foods in addition to the normal diet.

ERAS: Enhanced recovery after surgery; VTE: Venous thromboembolism; ONS: Oral nutritional supplements; CVC: Central venous catheter.

Comparison of observation indicators between two groups of patients

Intergroup comparisons showed that the observation group had significantly better outcomes than the control group in terms of time to bowel sound recovery (12.53 ± 1.21 hours), first time out-of-bed activity (23.53 ± 2.34 hours), length of hospital stay (6.63 ± 0.46 days), and overall complication rate (3.03%), with a significantly higher satisfaction rate (100% vs 80.81%; P < 0.05), as shown in Table 4.

Table 4 Comparison of observation indicators between the two groups (%).

Indicator	Observation group (n = 99)	Control group (n = 99)	t/χ²	P value
Time to bowel sound recovery (hours, mean ± SD)	12.53 ± 1.21	17.16 ± 1.07	28.521	0.000
First time out-of-bed activity (hours, mean ± SD)	23.53 ± 2.34	29.06 ± 1.89	18.293	0.000
Length of hospital stay (days, mean ± SD)	6.63 ± 0.46	9.26 ± 0.37	44.327	0.000
Patient satisfaction	100.0	80.81	21.017	0.000
Postoperative bleeding rate	1.01	5.05	1.547	0.214
Perforation incidence rate	0.00	6.06	4.297	0.038
Postoperative infection rate	2.02	7.07	1.862	0.172
Overall complication rate	3.03	18.18	11.986	0.001

DISCUSSION

With the evolution of medical models and the development of patients’ health needs, alleviating symptom burden and suffering has become one of the research priorities for patients with EGC after treatment. Therefore, reasonable and effective nursing interventions are crucial for improving patient prognosis[10]. Conventional nursing interventions are often empirical and lack specificity. The promotion and application of the MDT enable healthcare professionals to integrate specialized expertise and develop personalized nursing plans for patients, breaking down disciplinary barriers and achieving efficient information integration and synchronization through a structured communication platform[11]. At the same time, the MDT is not a simple stacking of personnel, but rather a precise allocation of resources based on patient needs. In this study, a coordinating nurse acted as a “hub”, ensuring that various nursing interventions were carried out by the right professionals at the right time, thereby avoiding waste or overlap of nursing resources. This aligns with the recently emphasized concept of “precision nursing”. Gandhi et al[12] argue that the early involvement of dietitians during the preoperative phase, rather than intervening only after signs of malnutrition appear, is key to shortening the length of hospital stay. Furthermore, Wu et al[13], through MDT-based care, placed patients at the center and significantly enhanced their disease awareness and self-efficacy via systematic, multi-faceted health education. This demonstrates that when patients fully understand the purpose of various interventions, their compliance improves substantially, thereby actively and proactively engaging in the rehabilitation process.

This study employed the Delphi method to establish a perioperative nursing indicator system for patients with EGC based on the three-dimensional theoretical model of structure-process-outcome. In terms of expert selection, all consulted experts possessed 8 years to 25 years of nursing experience in gastrointestinal diseases, ensuring the professionalism and reliability of the evidence sources. Additionally, two rounds of questionnaire surveys were conducted during the research process, achieving a 100% response rate for both rounds. The authority coefficients of the experts were 0.758 and 0.828 for the two rounds, respectively, meeting methodological requirements. The indicator system constructed in this study aligns with the nursing implications of current treatment concepts, closely focuses on key perioperative nodes, and features easily quantifiable and collectible indicators with strong clinical practicality. Through dynamic monitoring of outcome indicators, closed-loop management of nursing quality can be achieved.

With the rise of precision medicine, it is particularly important to construct a targeted quality evaluation indicator system for nursing care of EGC as a single disease category[14]. Current research mainly focuses on the severe physiological and psychological impact of the disease burden of EGC on patients’ families, while attention to perioperative interventions addressing issues such as negative emotions and intraoperative hypothermia remains insufficient[15]. The process indicators of the MDT model constructed in this study, based on previous research and expert opinions, fully considered various stressors. Expert weight analysis revealed that psychological nursing and intraoperative temperature management received relatively high weights of 0.0290 and 0.1003, respectively, suggesting that the MDT approach can reduce patient stress and is highly significant for promoting postoperative recovery. EGC patients face the risk of various complications after surgical treatment. One study indicated[16] that the readmission rate due to complications after treatment for EGC patients is 7.2%. Considering China’s national context, where current team service motivation is low and the support system is underdeveloped, the outcome indicators of the MDT model constructed in this study focus on the postoperative characteristics of EGC patients. Combined with expert weighting, the results indicate that complications are a critical factor affecting patient recovery. This highlights the need, during the critical window for postoperative complications, to optimize the “green channel” process for patient readmission. This ensures patients can receive timely medical assistance to the greatest extent, prevents nursing risks, and enhances nursing quality and patient safety[17].

Jeong et al[18] have confirmed that postoperative nursing interventions can significantly reduce bed rest time, accelerate the recovery of gastrointestinal function, and improve patients’ quality of life, which aligns with the findings of this study. The results of this study demonstrated that the time to bowel sound recovery and time to first ambulation in the observation group were significantly shorter than those in the control group (P < 0.05), suggesting that perioperative MDT care can facilitate the recovery of gastrointestinal function in patients. The potential reasons for these outcomes may be as follows: The preoperative nutritional management component of the MDT approach provided timely supplementation of essential nutrients after surgery, promoted protein synthesis, effectively improved the nutritional status of patients, and helped maintain the integrity of the intestinal mucosal barrier structure and function, thereby supporting the recovery of gastrointestinal function within a shorter period[19]. Additionally, scientifically guided early postoperative mobilization significantly enhanced patient metabolism, suppressed excessive sympathetic excitation, and promoted intestinal peristalsis. This alleviated symptoms such as flatulence, accelerated the return of bowel sounds, and further shortened the time to first ambulation[20]. Yu et al[21] reported that high-level nursing interventions reduced the length of hospital stay by a factor of 1.31 in surgical GC patients (P < 0.05). As nursing models following GC surgery continue to evolve and improve, this study implemented perioperative MDT care in EGC patients and found that the length of hospital stay in the observation group was significantly shorter than that in the control group (P < 0.05). This indicates that perioperative MDT care can effectively enhance treatment outcomes and alleviate the economic burden on patients’ families. Wang et al[22] reported that patients receiving homogeneous nursing care experienced a significant reduction of 39.10% in postoperative complications, indicating the superiority of effective nursing interventions in preventing postoperative complications. Zhang et al[23] reported that the satisfaction rate among EGC patients who received perioperative nursing was 85.00%, significantly higher than the 55.00% in the control group (P < 0.05), which is consistent with the conclusions of this study. This study also found that patient satisfaction in the observation group was significantly higher (P < 0.05). The underlying reason may be that the MDT model helps patients better understand EGC-related knowledge and surgical information through scientifically sound methods, encourages early ambulation and exercise, assists in establishing healthy lifestyle habits, strengthens rehabilitation confidence, and improves compliance. These collectively contribute to an enhanced quality of life and increased satisfaction with nursing care[24].

CONCLUSION

In summary, the perioperative MDT model for EGC patients constructed using the Delphi method in this study demonstrates high reliability. It effectively improves treatment outcomes, promotes the recovery of postoperative physiological indicators, and prevents complications. With its strong practicality and positive prognostic impact, this model warrants clinical promotion and application.