Implementation feasibility and early outcome trends of a nursing-led multimodal recovery protocol after urgent abdominal surgery: a prospective single-group evaluation study

Information from the abstract

Patients undergoing urgent open abdominal surgery commonly experience substantial pain and delayed gastrointestinal recovery. A structured nursing-led multimodal protocol may be practical in this setting, but evidence from urgent surgical wards in Thailand is limited. This study evaluated implementation feasibility and early outcome trends without testing comparative effectiveness. This prospective single-group implementation evaluation included adults undergoing first-time urgent exploratory laparotomy at King Narai Hospital, Thailand. The protocol combined structured pain assessment and physician-directed analgesia with deep-breathing exercises, sugar-free gum chewing, stepwise early mobilization, and behavior monitoring. Pain was recorded before surgery and at 24, 48, and 72 hours; a four-component bowel-motility score was recorded at 24, 48, and 72 hours. Analyses were descriptive and exploratory and included Friedman, Wilcoxon signed-rank, correlation, and parsimonious regression analyses. Forty-one participants had complete outcome data, below the planned target of 90. Median pain scores were 10.00 preoperatively and 5.00, 3.17, and 2.00 at 24, 48, and 72 hours, respectively; score distributions differed across time points, χ 2 (3) = 119.66, p < 0.001. Median bowel-motility scores were 5.00, 4.00, and 2.00 at 24, 48, and 72 hours, respectively; distributions also differed over time, χ 2 (2) = 78.00, p < 0.001. Median hospital stay was 6 days and median treatment cost was 23,765.75 Thai Baht. Delivering the protocol and completing repeated assessments was feasible in this single surgical ward, and pain and bowel-motility scores improved over the first 72 postoperative hours. These temporal changes cannot be attributed to the protocol because there was no comparator, natural postoperative recovery was expected, and the sample was smaller than planned. Controlled, adequately powered studies with objective gastrointestinal endpoints and detailed fidelity and analgesic data are needed. Not applicable.

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Related topics: Enhanced Recovery After Surgery · Music Therapy and Health · Nausea and vomiting management