Preoperative psychological nursing reduces stress and postoperative complications in patients undergoing ERCP: A prospective cohort study.

BACKGROUND

Endoscopic retrograde cholangiopancreatography (ERCP) induces substantial psychological distress and physiological stress responses that may adversely affect clinical outcomes. Although psychological nursing interventions have demonstrated efficacy in attenuating perioperative stress across various surgical settings, robust evidence regarding their application in ERCP remains limited.

OBJECTIVES

To evaluate the effectiveness of a structured preoperative psychological nursing intervention on psychophysiological stress responses and clinical outcomes in patients undergoing ERCP.

MATERIAL AND

METHODS

This prospective cohort study enrolled 297 consecutive patients undergoing ERCP at a tertiary care center between June 2022 and June 2025. Participants were allocated to either a control group (n = 148) receiving standard care or an intervention group (n = 149) receiving standard care plus a psychological nursing protocol comprising trust-building communication, procedural education, and relaxation training. The primary outcome was psychological stress measured using the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS). Secondary outcomes included intraoperative hemodynamic parameters, behavioral stress-response grades, and postoperative complication rates. Outcome assessors were blinded to group allocation.

RESULTS

Post-intervention, the intervention group demonstrated significantly lower anxiety (SAS: 28.92 ±4.78 vs 41.85 ±8.97; t-test: degrees of freedom (df) = 295; p < 0.001; Cohen's d = 1.79, 95% confidence interval (95% CI): 1.52-2.06) and depression (SDS: 27.89 ±5.14 vs 42.67 ±9.83; t-test: df = 295; p < 0.001; Cohen's d = 1.88, 95% CI: 1.61-2.15) scores compared with controls. Patients receiving the intervention exhibited superior intraoperative hemodynamic stability, including reduced heart rate variability (coefficient of variation: 0.07 ±0.03 vs 0.14 ±0.06; t-test: df = 295; p < 0.001) and fewer severe behavioral stress responses (grade III: 0% vs 7.4%; ÷2 test: df = 2; p < 0.001). The intervention group experienced significantly fewer overall postoperative complications (12.1% vs 27.7%; ÷2 test: df = 1; p = 0.001; risk ratio (RR) = 0.44, 95% CI: 0.26-0.73; number needed to treat (NNT) = 6.4).

CONCLUSIONS

Structured preoperative psychological nursing intervention significantly attenuates psychophysiological stress responses and reduces postoperative complications in patients undergoing ERCP. These findings support integration of psychological support protocols into perioperative care pathways, although confirmation through multicenter randomized controlled trials is warranted.