Effect of dynamic bundled positioning care on postoperative position-related transient neurological symptoms in patients undergoing robot-assisted lobectomy: A prospective cohort study.

Position-related transient neurological symptoms (PTNS) may occur after robot-assisted thoracic surgery (RATS) because of prolonged lateral positioning and upper-limb fixation. Evidence on effective nursing strategies for preventing PTNS in this setting remains limited. This single-center prospective observational cohort study was conducted from May 2022 to April 2023 within a registered cohort of patients undergoing RATS lobectomy. Consecutive eligible patients received conventional positioning care during the earlier study period and bundled positioning care during the later period. The bundled protocol included standardized positioning, post-docking readjustment, targeted pressure relief, and scheduled intraoperative inspection. The primary outcome was definite PTNS at 24 h. Among 289 patients, definite PTNS occurred in 28 of 144 patients (19.4%) receiving conventional care and 6 of 145 (4.1%) receiving bundled care. Bundled positioning care was associated with a lower risk of definite PTNS after multivariable adjustment (adjusted odds ratio = 0.18, 95% confidence interval 0.07-0.45, P < 0.01), with consistent findings in sensitivity analyses. Secondary neurological and position-related outcomes generally showed similar associations. Dynamically adjusted bundled positioning care was associated with a lower incidence of postoperative PTNS after RATS lobectomy and may have practical value in perioperative nursing.