Association of a standardized nursing protocol with postoperative complications following open radical gastrectomy: a retrospective cohort study.

OBJECTIVES

To evaluate the independent association of a standardized, multi-modal intraoperative nursing protocol on postoperative complications in patients undergoing open radical gastrectomy for gastric cancer.

METHODS

This retrospective cohort study included 89 patients who underwent open radical gastrectomy. Patients were categorized into a standardized care group (n=44) receiving a multi-modal nursing protocol and a non-standardized care group (n=45). The primary outcome was 30-day complications (Clavien-Dindo ≥II). Multivariable logistic regression adjusted for confounders.

RESULTS

A total of 89 patients were included (standardized care group, n=44; non-standardized care group, n=45). The total complication rate was significantly lower in the Standardized Care Group (22.7 % vs. 48.9 %, p<0.01). After adjustment, standardized nursing care was independently associated with reduced complications (adjusted OR=0.32; 95 % CI: 0.12-0.85; p=0.022). Intraoperative hypothermia (OR=3.45; 95 % CI: 1.42-8.38) and operative time ≥200 min (OR=2.89; 95 % CI: 1.18-7.07) were identified as independent risk factors.

CONCLUSIONS

In the context of open gastrectomy, a systematic intraoperative nursing protocol is significantly and independently associated with reduced postoperative morbidity, primarily by being associated with lower rates of procedure-specific risks such as hypothermia and prolonged operative time. This study provides quantitative evidence to support reconceptualizing structured operating room nursing from a supportive role to a core component of therapeutic intervention associated with improved surgical outcomes.