Impact of intelligent information-based perioperative care on postoperative rehabilitation, complications, and quality of life of patients undergoing gastrointestinal surgery

Abstract

To investigate the impact of perioperative intelligent information-based care on postoperative rehabilitation, complications, and quality of life of patients in the operating room. Retrospective analysis of information on 84 patients who underwent gastrointestinal surgery in our hospital from May 2021 to May 2022 were divided into to control group (n = 42) and observation group (n = 42) according to different care modalities. The control group received conventional care, while the observation group received intelligent information-based perioperative care. The total postoperative treatment time, length of stay, Pittsburgh Sleep Quality Index score, Pain Numerical Rating Scale score, Hamilton Anxiety Scale score, Hamilton Depression Scale score, complication rate, quality of life score, and nursing satisfaction were observed. The total postoperative treatment time and total hospital stay in the observation group were significantly shorter than that of the control group (P < .05). After care, the Pittsburgh Sleep Quality Index and Numerical Rating Scale scores in the observation group were significantly lower than that of the control group (P < .05). After care, Hamilton Anxiety Scale and Hamilton Depression Scale scores were significantly lower in both groups, and the observation group was lower than the control group (P < .05). The complication rate in the observation groups was 11.9% (5/42), which was significantly lower than that of 47.62% (20/42) in the control group (P < .001). The quality of life of patients such as physical ability, pain, mood, sleep, social activity, and physical activity scores in the observation group were significantly lower than that of the control group after care (P < .05). The nursing satisfaction rate of patients in the observation group was 95.27% (40/42), which was significantly higher than that of 78.57% (33/42) in the control group (P = .024). Intelligent information-based perioperative care can promote the postoperative recovery of patients undergoing gastrointestinal surgery, can successfully improve patients’ sleep quality and pain level, alleviate negative emotions, reduce the risk of postoperative complications, and improve patients’ quality of life and satisfaction, which is worthy of clinical promotion.

1. Introduction

Operations, as the main treatment method of surgery, are the way of excising and suturing the diseased part of the patient’s body by using corresponding medical devices, aiming at treating or diagnosing the disease, so as to maintain the body’s health.^[1] It is widely used for patients with the disease. Gastrointestinal surgery is a risky and invasive treatment with unique features that often put patients at the edge of life and death. The safety of surgery depends not only on the surgeon’s operational skills, but also on the effective cooperation of nursing staff. Therefore, a rational and efficient model of care is very important for surgical patients.^[2] Patients with gastrointestinal surgery have low postoperative immunity and are prone to infection, so the operating room is one of the high-risk areas for nosocomial infections.^[3]

Nosocomial infection refers to the disease caused by nosocomial infection of pathogenic bacteria, which can affect the skin, digestive and respiratory systems and cause symptoms such as pruritus, abdominal pain, diarrhea, cough and sputum.^[4,5] It may also cause serious complications such as septicemia, internal environment disorder and organ failure, endangering the life and health of patients.^[6] Some pathogens widely present in hospitals can cause airborne, contact infections and therefore have very serious consequences.^[7] Patients with low immunity and long hospital stays are more likely to be infected.^[8] Nosocomial infections not only affect the postoperative recovery of patients undergoing gastrointestinal surgery, but also may bring about nurse–patient disputes and cause adverse effects. Therefore, enhancing the nursing management of patients undergoing gastrointestinal surgery in the operating room is important to avoid nasal infections, improve patient prognosis, and increase nursing satisfaction.^[9]

Currently, the medical needs of patients undergoing gastrointestinal surgery are no longer limited to pharmacological treatment, and more attention is being paid to the nursing care they enjoy during their own treatment. In addition, the quality of care directly affects the prognosis of patients. The traditional model of care emphasizes disease-centered care services while ignoring the care needs of the patients themselves. With the widespread application of computer technology, intelligent information management systems are increasingly used in hospital clinical management. Intelligent information management system demonstrates powerful data collection, analysis and processing capabilities.^[10] Intelligent information operating room nursing management model can improve the technical operation level of operating room nurses and the management quality of infection prevention and control in the operating room and reduce the hospital infection rate.^[11] It is suggested that the nursing management model of intelligent information operating room is a nursing model with better quality of care. At present, the nursing management model of intelligent information operating room has been applied to a certain extent in clinical practice. Using the advantages of intelligent information technology to strengthen the nursing management of the operating room is conducive to improving the quality and efficiency of nursing services in the department and reducing the risks of the traditional nursing model. It can facilitate postoperative recovery of surgical patients, but there are few studies on the impact of smart information-based perioperative care on postoperative recovery, complications, and quality of life of patients undergoing gastrointestinal surgery in the operating room. In view of this, this study focused on 84 patients admitted to our hospital for gastrointestinal surgery from May 2021 to May 2022. The purpose of this study was to determine whether intelligent information-based perioperative care can facilitate postoperative recovery in patients undergoing gastrointestinal surgery and to provide new care strategies to improve the clinical prognosis of such patients.

2. Materials and methods

2.1. Clinical information

According to the prevalence of the disease, the sample size was calculated using the formal: n = Z²(p*q)/d². Take Z = 1.96, where p is the overall rate, q = 1−p. Let P = .8, d is a fraction of p. Finally, 84 patients undergoing gastrointestinal surgery in the operating room from May 2021 to May 2022 were included and assigned to the control group (n = 42) and the observation group (n = 42) according to different methods of care. The observation group received intelligent information-based perioperative nursing in comparison with the control group, which received routine nursing. Ethical approval for this study was obtained from the hospital ethics committee.

2.2. Inclusion and exclusion

Inclusion criteria: (1) patients with indications for gastrointestinal surgery and undergoing gastrointestinal surgery; (2) patients undergoing search for the first time for gastrointestinal surgery-guided disease; (3) patients were conscious and had stable vital signs; (4) patients gave informed consent to this trial and signed an informed consent form.

Exclusion criteria: (1) patients with primary sleep disorders; (2) patients with neurodegenerative or metabolic diseases; (3) patients who have difficulty undergoing surgery due to their nutritional status; (4) patients with other serious diseases; (5) patients with a history of drug and alcohol abuse; (6) patients who have undergone gastrointestinal surgery.

2.3. Methods

Patients in the control group underwent a routine nursing intervention. Patients were instructed to fast 12 hours prior to surgery and 4 hours prior to surgery, and gastrointestinal operators instructed patients to eat a liquid diet 1 to 3 days prior to surgery. The fasting time was the same as the normal operator. Electrolytes and glucose were replenished intravenously. During the process, the precautions in the routine guidance operation were paid attention to, and the patients were provided with daily care. Patients were placed in a reasonable lying position after the surgery, combined with the mode of anesthesia. The monitoring of the changes of their condition and surgical incision was strengthened. With appropriate treatment in a timely manner, when the physiological function was stable and the airway is unobstructed, the appropriate time was chosen to perform extubation care.

Care for patients in the observation group was implemented based on the study group’s intelligent information, as follows:

1. Establishment of an intelligent information operation room. The main points are as follows. (1) The ward was equipped with a variety of intelligent equipment and technologies, such as computers, cameras, temperature and humidity, and sterilization control systems, which were used and managed by the operating room in a unified manner, and an intelligent operation desk was established to enable live broadcasting, display, and teaching. (2) The operating room nurses were trained in safety and protection knowledge and skills. The awareness of disinfection and sterilization of the operating room nurses was strengthened. The relevant rules and regulations of the operating room were clarified and observed, and medical staff were required to master and use the relevant new equipment. (3) Before surgery, nurses transmitted the patient’s personal case information to the computer, analyzed the patient’s condition and type of surgery, designed the scientific and reasonable plan out, and made the staffing arrangements. (4) With reference to the cleanliness standards of class IV operating rooms, the room temperature and dry humidity were set, and positive pressure was maintained in the room. The air in the operating room is replaced with an air purifier every 10 minutes and the air is disinfected.^[12] (5) Strengthen the management of the operating room staff. Camera monitoring is performed in the operating room and a fingerprint access control system is established to strengthen the supervision of the nursing behavior norms of the operating room staff. Before entering the operating room, hand washing and disinfection are required, surgical gowns are properly worn, and the number of times that operating room staff can enter and exit the operating room is strictly limited. Re-sterilization of hands is required when entering and leaving the operating room, and monitoring equipment is used for supervision. (6) Establish an information tracking management system. Use this management system to categorize and distribute medications and medical devices needed by patients and to adequately sterilize them in advance. Disposable medical supplies are best carried.

2. Nursing measures. (1) Environmental care. The operating room temperature is maintained at 22–24 °C during surgery, the operating room is clean and tidy, and aseptic operations are strictly enforced. To maintain the patient’s dignity, try to avoid body and protect the patient’s privacy as much as possible. After the operation, the patient was covered with a quilt and sent to the designated ward with the assistance of the patient’s family. (2) Pre- and postoperative psychological care. Patients have fear of surgery before surgery, nurses should give them psychological counseling and reduce their psychological pressure to reduce their fear of surgery. Due to the severe postoperative pain, patients are prone to anxiety, tension and psychological pressure. Therefore, nurses should take the initiative to communicate with patients to relieve their negative emotions, divert their attention and reduce pain. Encourage the patient’s family to care more about the patient and increase the family’s support for the patient. (3) Guidance of sleep habits. Encourage patients to develop good sleep habits, prohibit the consumption of caffeinated beverages at night, and strictly control the intake of fat and calories in their daily diet. They should also be encouraged to maintain good personal hygiene and be helped to adopt appropriate sleep positions to increase sleep comfort. For patients with severe insomnia, sleeping pills can be taken reasonably under the guidance of the doctor. (4) Postoperative incision care. Appropriate positions will be selected according to the patient’s condition. Careful care will be given to the surgical incision site and assistance with bowel movements. Patients are provided with continuous quality care after surgery, and catheters are changed in a timely manner to prevent infection. Patients with postoperative pain received music therapy to relieve pain. (5) Safety management care. Conduct personalized disease knowledge education to help patients gain health awareness. Arrange nurses to visit the ward on time, and nurses accompany patients out for checkups to ensure patients’ comfort in the hospital. (6) Post-discharge care. Provide discharge instructions and issue contact cards according to the patient’s condition and recovery. The nurse should patiently inform the patient and family of the post-discharge diet. Monitor patients for complications by telephone throughout the postoperative period.

2.4. Observation index

Assessments were performed before and after 1 week of care: (1) to observe patients’ total postoperative treatment time and length of stay. (2) Patients’ Pittsburgh Sleep Quality Index (PSQI) scores were observed.^[13] It ranged from 0 to 21, with lower PSQI scores indicating better sleep quality. (3) Patients were observed for physical pain. The level of pain was assessed using a Numerical Rating Scale (NRS).^[14] The NRS has a score of 0–10, with higher scores indicating more pain. (4) Observation of patients’ psychological status. The Hamilton Anxiety Scale (HAMA)^[15] and Hamilton Depression Scale (HAMD)^[16] were used to evaluate the psychological status of patients before and after care. Lower scores on the HAMA and HAMD scales were associated with less anxiety and depressive symptoms and vice versa. (5) The incidence of postoperative complications was observed. Possible complications included incisional infection, lower extremity venous thrombosis, and accelerated heart rate. (6) Satisfaction with nursing care was observed. Content of care, quality of care, and nursing skills were surveyed using a homemade satisfaction questionnaire. Total scores ranged from 0 to 40. Cases with a score of 30 or more were considered very satisfied, those with a score between 20 and 30 were considered satisfied, and those with a score below 20 were considered unsatisfied. Nursing satisfaction rate = (very satisfied + satisfied) cases/total cases × 100%.

2.5. Statistical analysis

SPSS 19.0 was applied to data analysis. Counting data were expressed as n (%) and compared using χ2 test, while measurement data were expressed as mean ± standard deviation. Measurement data were compared using t test (normal distribution) and Mann–Whitney U test (non-normal distribution). P < .05 denoted that the difference was statistically significant.

3. Results

3.1. Comparison of the basic data between the 2 groups

There were 28 males and 14 females in the control group, all between 28 and 67 years of age, and their mean age was (42.33 ± 14.41) years. The types of gastrointestinal procedures included gastric ulcer repair (n = 20), subtotal gastrectomy (n = 10) and endoscopic gastric polypectomy (n = 12). There were 27 males and 15 females in the observation group, all between 27 and 68 years of age, and their mean age was (42.88 ± 14.34) years. The types of gastrointestinal procedures included gastric ulcer repair (n = 19), subtotal gastrectomy (n = 11), and endoscopic gastrectomy for gastric polyps (n = 12). Data from the general population showed no significant differences (P > .05, Table 1).

Table 1.

Comparison of the basic data between the 2 groups.

Group	n	Age (years)	Gender		Types of gastrointestinal procedures
			Male	Female	Gastric ulcer repair	Subtotal gastrectomy	Gastric polyps
Control group	42	42.33 ± 14.41	28	14	20	10	12
Observation group	42	42.88 ± 14.34	27	15	19	11	12
t/χ²		1.268	0.053		0.073
P		0.504	0.818		0.964

3.2. Comparison of total postoperative treatment time and length of stay between the 2 groups

Compared with the control group, the total postoperative treatment time and total hospital stay were significantly shorter in the observation group (P < .05, Table 2).

Table 2.

Comparison of total postoperative treatment time and length of stay between the 2 groups.

Group	n	Total postoperative treatment time(d)	Hospitalization time (d)
Control group	42	12.41 ± 3.08	15.31 ± 2.15
Observation group	42	9.04 ± 0.26	9.41 ± 1.64
t		7.067	14.14
P		.03	.01

3.3. Comparison of PSQI and NRS scores between the 2 groups

Before care, PSQI and NRS scores did not show significant differences (P > .05). After 1 week of care, PSQI and NRS scores were significantly lower than before care (P < .05). Compared with the control group, the PSQI and NRS scores were significantly lower in the observation group (P < .05, Table 3).

Table 3.

Comparison of PSQI and NRS scores between the 2 groups.

Group	N	PSQI scoring		NRS scoring
		Before nursing	After a week of nursing	Before nursing	After a week of nursing
Control group	42	12.41 ± 2.72	8.45 ± 1.32*	5.26 ± 1.22	2.48 ± 0.31†
Observation group	42	12.51 ± 2.45	5.51 ± 1.08‡	5.18 ± 1.25	1.17 ± 0.15§
t		0.177	11.172	0.297	24.652
P		.204	.02	.286	.04

^*PSQI scores before and after care in the control group, P < .05.

^†NRS scores before and after care in the control group, P < .05.

^‡PSQI scores before and after care in the observation group, P < .05.

^§NRS scores before and after care in the observation group, P < .05.

3.4. Comparison of HAMA and HAMD scores between the 2 groups

Before care, HAMA scores and HAMD scores did not show significant differences (P > .05). After 1 week of care, HAMA and HAMD scores were significantly lower than before care (P < .05). Compared with the control group, the HAMA and HAMD scores of the observation group was significantly lower (P < .05, Table 4).

Table 4.

Comparison of HAMA and HAMD scores between the 2 groups.

Group	n	HAMA scoring		HAMD scoring
		Before nursing	After a week of nursing	Before nursing	After a week of nursing
Control group	42	17.83 ± 3.26	11.32 ± 2.25*	16.54 ± 2.87	10.61 ± 2.08†
Observation group	42	17.91 ± 3.08	7.46 ± 2.08‡	16.61 ± 3.04	7.21 ± 2.05§
t		0.116	8.164	0.109	7.545
P		0.862	0.007	0.717	0.011

^*HAMA scores before and after care in the control group, P < .05.

^†HAMD scores before and after care in the control group, P < .05.

^‡HAMA scores before and after care in the observation group, P < .05.

^§HAMD scores before and after care in the observation group, P < .05.

3.5. Comparison of complication rates between the 2 groups

After care, the complication rate in the observation groups was 11.9% (5/42), which was significantly lower than that of 47.62% (20/42) in the control group (P < .001, Table 5).

Table 5.

Comparison of the complication rates between the 2 groups.

Group	N	Incision infection	Lower extremity venous thrombosis	Anastomotic leakage	Abdominal distension	Vomit/regurg	Total incidence rate
Control group	42	1	3	3	4	9	20 (47.62%)
Observation group	42	0	1	0	1	3	5 (11.9%)
t							12.81
P							<.001

3.6. Comparison of the quality of life after 1 week of care between the 2 groups

Compared with the control group, in the observation group, the quality of life of patients such as physical ability, pain, mood, sleep, social activity, and physical activity scores were significantly lower after one week of care (P < .05, Table 6).

Table 6.

Comparison of the quality of life after 1 week of care between the 2 groups.

Group	n	Physical capacity	Pain	Emotion	Sleep	Social activities	Physical activity
Control group	42	36.34 ± 7.04	53.38 ± 5.21	46.58 ± 5.24	50.66 ± 2.71	53.41 ± 4.09	57.66 ± 5.21
Observation group	42	31.26 ± 4.41	47.55 ± 4.26	40.41 ± 5.17	37.05 ± 5.08	44.14 ± 6.22	48.27 ± 3.32
t		3.963	5.614	5.432	15.319	8.07	9.851
P		.015	.006	.026	.031	.002	.001

3.7. Comparison of the nursing satisfaction rate after 1 week of care between the 2 groups

After care, the nursing satisfaction rate of patients in the observation group was 95.27% (40/42), which was significantly higher than that of 78.57% (33/42) in the control group (P = .024, Table 7 and Fig. 1).

Table 7.

Comparison of the nursing satisfaction rate after 1 week of care between the 2 groups.

Group	N	Very satisfied	Satisfied	Dissatisfied	Satisfaction rate (%)
Control group	42	15	18	9	33 (78.57%)
Observation group	42	27	13	2	40 (95.24%)
t					5.13
P					.024

Figure 1.

Comparison of the nursing satisfaction rate between the 2 groups.

4. Discussion

The operating room is an important place where patients are operated on and resuscitated.^[17] Surgical treatment entails removal of diseased tissues, transplantation of organs or repair of injuries and can be used to treat patients with gastrointestinal disorders. Fear and apprehension are common among patients with gastrointestinal disorders, which not only hinders the smooth performance of surgery, but also affects the efficacy of the procedure. Therefore, an efficient care model is significant for improving safety and quality of care in the operating room, thereby ensuring the safety of care for patients undergoing gastrointestinal surgery, improving patient prognosis, and increasing nursing satisfaction rates.

With the improvement of social living standards and the development of medicine, quality care is gradually promoted and applied in clinical practice. Intelligent information-based perioperative nursing service can take patients as the center, consider their needs comprehensively, strengthen basic nursing care, and provide patients with perfect quality services. The implementation of quality nursing services replaces the previous passive nursing services with a new active service model to improve the nursing effect and provide safe, high-quality and satisfactory nursing services for patients.^[18,19] At the same time, nurses should do a good job in the prevention and care of postoperative complications to reduce patients’ pain and speed up the recovery process.^[18–20] Therefore, this paper examines the impact of perioperative care on patient recovery, complications and quality of life after surgery using patient intelligence information-based.

The results showed that the total postoperative treatment time and hospital stay of the observation group were significantly shortened, and the complication rate of the observation group was significantly reduced. It shows that compared with traditional perioperative care, intelligent information-based perioperative care can significantly shorten the postoperative treatment time and hospital stay of patients undergoing gastrointestinal surgery in the operating room, reduce the occurrence of complications, and promote rapid patient recovery. The reasons for this can be explained as follows.^[21–24] First of all, the quality of nursing care in the operating room is directly determined by the technical level, service attitude and awareness of nurses. Nurses strictly follow the operation specification of the operating room and have a clear service attitude and consciousness, which are all important elements of nursing care. The perioperative care model based on smart information technology firstly requires training nurses how to use the corresponding equipment correctly, which ensures the smooth nursing management in the smart information technology operating room and also facilitates the smooth daily work of the hospital and the perioperative care model based on smart information technology. Operating room staff are prone to management oversights due to their heavy daily workload. Intelligent information-based can input and adapt the patient and operating room to the system to ensure smooth preoperative management and operating room operations, thus improving the clinical prognosis of patients. In addition, several studies have shown that surgical infections can be caused by the air in the operating room, the instruments used, and the hand hygiene of medical staff. During surgery, bacteria from outside the operating room can enter the operating room and increase the risk of surgical infection. Therefore, it is very important to strictly control the number of medical staff entering and leaving the operating room during surgery. However, conventional operating rooms lack proper control measures. The movement of medical personnel greatly increases the bacterial content of the air in the operating room, leading to an increased risk of surgical infections.^[25,26] Intelligent and informative perioperative care using access control systems can not only effectively restrict the entry of outdoor personnel, but also record the entry and exit to achieve good control and reduce the risk of surgical infection. Then, surgical infection is also closely related to the operation time; the longer the operation time, the longer the exposure of the incision, the more likely it is to lead to surgical infection. Therefore, doctors and nurses in the operating room are required to have high comprehensive ability and operational tacit understanding in order to improve the quality of work, promote smooth surgical procedures, avoid wasting surgical time, and reduce the risk of surgical infection.

The results showed that the PSQI and NRS scores were lower in the observation group. After care, the HAMA and HAMD scores were significantly lower than before care, compared to the control group with lower HAMA and HAMD score scores in the observation group. The scores of physical ability, pain, mood, sleep, social activity, and physical activity were lower in the observation group. The nursing satisfaction rate was significantly higher in the observation group. Intelligent information-based perioperative care was proven to significantly alleviate negative emotions, improve sleep quality, and quality of life in gastrointestinal surgery patients in the operating room compared with traditional perioperative care, resulting in greater patient satisfaction. This is mainly because intelligent information-based perioperative care emphasizes patient-centeredness, provides them with more comfortable, high-quality, targeted, and humanized nursing services, strengthens psychological counseling while establishing a good nurse-patient relationship, reduces patients’ anxiety and depression, improves their treatment compliance, puts them in the best physical and mental state during treatment, and accelerates their recovery progress. In addition, perioperative care based on intelligent information not only improves the efficiency of nursing staff and their ability to provide quality nursing services, but also effectively improves the correct perception of patients and their families and enhances their cooperation and compliance, mainly by improving nursing staff’s nursing capacity, optimizing patients’ preoperative environment, and strengthening health education, and psychological intervention. Negative emotions such as tension, anxiety, and anxiety caused by unfamiliar environment and cognitive deficiencies were further alleviated. The sleep quality and quality of life issues caused by negative emotions were resolved, enabling them to accept the surgery with a positive attitude. In addition, through the improvement of intraoperative environment and warm care, the physical and mental comfort of patients was further improved, which made them trust nurses more and formed a good cooperative relationship, which greatly improved nursing satisfaction. Finally, through postoperative condition and body monitoring, healthy diet guidance and complication prevention, a comprehensive and favorable rehabilitation treatment environment was provided for patients. Patients’ physical and mental health, sleep quality, and poor mood were also effectively improved.^[27,28]

In conclusion, intelligent information-based perioperative care can significantly promote postoperative recovery of patients undergoing gastrointestinal surgery in the operating room, and can successfully improve patients’ sleep quality and pain, alleviate negative emotions, and reduce the risk of postoperative complications. For patients’ quality of life and satisfaction, it is worth promoting. However, this study still has some limitations. Although the sample size of this clinical trial was small, many cases were included. All cases were from a single medical center, and the follow-up time of the cases was relatively short, so future prospective studies with large sample centers are needed.

Author contributions

Conceptualization: Xiaoyu Li.

Data curation: Xiaoyu Li.

Formal analysis: Xiaoyu Li.

Funding acquisition: Xiaoyu Li.

Investigation: Xiaoyu Li.

Methodology: Xiaoyu Li, Haiqin Tang, Lifang Tang, Fengqin Tao.

Project administration: Xiuzhi Guo, Xiaoyu Li, Haiqin Tang, Lifang Tang, Fengqin Tao.

Resources: Xiuzhi Guo, Haiqin Tang, Lifang Tang.

Software: Xiuzhi Guo, Haiqin Tang, Lifang Tang, Fengqin Tao.

Supervision: Xiuzhi Guo, Haiqin Tang, Lifang Tang, Fengqin Tao.

Validation: Xiuzhi Guo, Haiqin Tang, Lifang Tang, Fengqin Tao.

Visualization: Xiuzhi Guo, Haiqin Tang, Lifang Tang.

Writing – original draft: Xiuzhi Guo.

Writing – review & editing: Xiuzhi Guo, Hengyan Zhuge.