Application of the Omaha System-Based Nursing Model in the Perioperative Care of Patients Undergoing Pancreaticoduodenectomy.

OBJECTIVE

To evaluate whether a nurse-delivered perioperative clinical pathway operationalized through the Omaha System is associated with improved recovery outcomes after pancreaticoduodenectomy (PD).

METHODS

This single-center pilot study used allocation by admission sequence. Sixty-eight adults undergoing PD from February to September 2025 were allocated to routine perioperative nursing (control, n = 34) or routine care plus a nurse-delivered Omaha System-based pathway (observation, n = 34). Outcomes were time to first flatus, defecation, and ambulation; abdominal distension on postoperative days (PODs) 1, 3, 7, and 14; ISI and HADS scores at admission and POD 7; and postoperative complications. Continuous and repeated measures were analyzed using t tests and repeated-measures analysis of variance, respectively; the overall complication proportions were compared using a two-sided Fisher's exact test.

RESULTS

Compared with the control group, the observation group had shorter times to first flatus, defecation, and ambulation (all P < 0.05), lower abdominal distension scores on PODs 3 and 7 (P = 0.015 and P < 0.001), and lower ISI, HADS-A, and HADS-D scores on POD 7 (all P < 0.001). Complications occurred in 2/34 (5.88%) observation-group patients and 8/34 (23.53%) control-group patients; this descriptive difference was not statistically significant by two-sided Fisher's exact test (P = 0.083).

CONCLUSION

The nurse-delivered Omaha System-based pathway was associated with faster gastrointestinal and mobility recovery and better sleep and psychological outcomes in this pilot sample. The lower observed complication proportion should be interpreted as a descriptive trend because the study was small, single-center, and not designed or powered for adjusted complication analyses. Larger multicenter randomized trials with implementation-fidelity monitoring are needed.