Observation of the impact of applying the fast track surgery concept during the perioperative period of breast-conserving surgery for breast cancer on the effectiveness of patient care and complications

Abstract

Objective

To observe the impact of applying the fast track surgery (FTS) concept during the perioperative period of breast-conserving surgery for breast cancer on the effectiveness of patient care and the occurrence of complications.

Methods

A retrospective analysis of clinical data was conducted for 92 cases of breast cancer patients admitted to our hospital from January 2022 to January 2023. All patients underwent breast-conserving surgery at our hospital and met the inclusion criteria. Patients were divided into two groups based on the different nursing interventions during the perioperative period: the control group (n = 46) received conventional nursing interventions, while the observation group (n = 46) received nursing interventions based on the fast track surgery concept. The nursing effectiveness, postoperative recovery, serum inflammatory factor levels, psychological negative emotions, and complication occurrence were compared between the two groups.

Results

The overall nursing effectiveness rate in the control group was 80.43%, while it was 95.65% in the observation group, which was significantly higher than that in the control group (P<0.05). The observation group showed significantly shorter times for getting out of bed, drainage removal, initiation of oral intake, wound healing, and hospital stay, as well as lower levels of pain compared to the control group (P<0.05). Before intervention, there were no significant differences in IL-6, TNF-α, and NF-κB levels between the two groups (P>0.05). However, after intervention, the levels of IL-6, TNF-α, and NF-κB in the observation group were significantly lower than those in the control group (P<0.05). Before intervention, there were no significant differences in SAS and SDS scores between the two groups (P>0.05). However, after intervention, the SAS and SDS scores in the observation group were significantly lower than those in the control group (P<0.05). The complication rate in the control group was 23.91%, while it was 8.70% in the observation group, and the observation group had a significantly lower complication rate than the control group (P<0.05).

Conclusion

The application of the fast track surgery concept during the perioperative period of breast-conserving surgery for breast cancer yields favorable results. Compared to conventional nursing interventions, fast track surgery concept-based nursing further enhances patient outcomes, improves the body’s inflammatory response, and mitigates adverse emotions, thereby accelerating patient recovery and reducing the risk of surgery-related complications. This approach is worthy of clinical promotion.

Introduction

Breast cancer, as a common malignant tumor among women, has become a major global challenge to women’s health [1]. Data shows that breast cancer occupies the highest position in the global incidence rate of female cancers, significantly affecting women’s lives and well-being [2]. In this context, breast-conserving surgery, as an option for preserving a patient’s breast and restoring their physical appearance, has garnered widespread attention and adoption [3]. The goal of breast-conserving surgery is not only to treat cancer but also to provide patients with a better quality of life and psychological well-being [4]. However, despite being an important treatment option for breast cancer patients, breast-conserving surgery comes with a series of postoperative recovery challenges and potential complications. These include postoperative pain, infections, lymphedema, wound healing issues, among others, which may trouble patients and even impact treatment outcomes [5]. Therefore, in the postoperative perioperative care, how to alleviate these problems and promote patients’ recovery to the maximum extent is a challenging task.

In recent years, the concept of fast track surgery (FTS) as a new perioperative care model has gradually gained widespread attention and application globally [6]. This concept emphasizes providing comprehensive and personalized nursing interventions for patients through multidisciplinary collaboration, including surgeons, nurses, rehabilitation therapists, etc., to minimize surgical trauma and improve patients’ postoperative quality of life [7]. In breast-conserving surgery for breast cancer, the application of the fast track surgery concept is considered to have significant potential to improve patients’ postoperative experience, reduce the risk of complications, shorten hospital stays, and thus alleviate the burden on healthcare resources. The purpose of this study is to explore in-depth the impact of applying the fast track surgery concept in the perioperative care of breast cancer patients undergoing breast-conserving surgery on the effectiveness of nursing and the occurrence of complications. Through a retrospective analysis of clinical data from 92 cases of breast cancer patients, we divided the patients into a control group and an observation group, and compared in detail the differences between the two groups in nursing effectiveness, postoperative recovery, inflammatory factor levels, psychological status, and the incidence of complications. This will help comprehensively assess the practical effectiveness and clinical application value of fast track surgery concept-based nursing and provide new theoretical and practical basis for perioperative care of breast cancer patients undergoing breast-conserving surgery. Additionally, this study also holds interdisciplinary significance by offering insights and accumulating experiences for the broader application of the fast track surgery concept in other surgical fields. By conducting in-depth research on the effectiveness of different nursing models during the perioperative period, we aim to provide feasible pathways for improving the postoperative experience of surgical patients and enhancing treatment outcomes.

Materials and methods

Study subjects

A retrospective analysis was conducted on 92 breast cancer patients who underwent breast-conserving surgery at our hospital between January 2022 and January 2023. Based on the standardized perioperative nursing protocols in place during their admission period, the patients were divided into two groups: the control group (n = 46), who received conventional nursing care from January to June 2022, and the observation group (n = 46), who received nursing care based on the Fast Track Surgery (FTS) concept from July 2022 to January 2023. This study was approved by the ethics committee of Harbin Medical University Cancer Hospital. Informed consent was obtained from all study participants. This study was conducted in accordance with the principles of the Helsinki Declaration [8].

Inclusion and exclusion criteria

Inclusion Criteria ① Patients diagnosed with breast cancer through histological or cytological examination, including primary breast cancer and locally recurrent breast cancer. ② Patients who underwent breast-conserving surgery for the treatment of breast cancer, including breast partial resection or breast resection with breast reconstruction procedures (such as breast reconstruction surgery). ③ Patients aged 18 years or older. ④ Patients in good nutritional status, capable of tolerating surgery and anesthesia. ⑤ Patients with normal upper limb function, complete medical histories, and comprehensive clinical data available for analysis.

Exclusion Criteria ① Patients diagnosed with advanced breast cancer or with distant metastasis. ② Patients with severe cardiovascular, respiratory, or other significant organ diseases. ③ Patients with immune system disorders. ④ Patients with severe mental illness or cognitive impairments. ⑤ Patients with other malignant tumors. ⑥ Patients with incomplete clinical data and information.

Methods

Control group

Patients in the control group received routine perioperative nursing interventions, including the following measures: admission education, basic nursing care, health education, observation of the patient’s condition, psychological care, and discharge guidance. Regarding preoperative preparation, patients in the control group underwent the routine 8-hour fasting and 4-hour restriction of water intake. During the surgery, the control group patients received a standard fluid intake control of 2500–3000 ml. Postoperatively, they were allowed to start eating or drinking 6–12 h after surgery, and nursing staff encouraged limb activity and functional exercises.

Observation group

Patients in the observation group received interventions based on the fast track surgery (FTS) concept, in addition to the nursing measures provided to the control group. The specific measures were as follows: (1) FTS Nursing Team and Protocol: A perioperative nursing team based on the Fast Track Surgery (FTS) concept was established. The team members included one head nurse from the operating room (overall coordinator), one nurse from the PACU, one oncologist, one anesthesiologist, and one nurse each from the nutrition and rehabilitation departments, all with more than five years of specialized experience. The team held weekly coordination meetings to develop individualized FTS nursing plans based on each patient’s condition. Nursing interventions continued for two weeks after discharge, during which home rehabilitation was guided through telephone follow-ups twice a week. (2) Preoperative visits and rehabilitation education were improved, along with psychological and dietary interventions. Nurses and doctors jointly participated in the preoperative visits to communicate with patients and their families, gaining their trust and cooperation. In addition to routine education, surgical and anesthesia doctors explained the FTS-based procedures and their benefits to improve patient compliance. Nurses assessed whether patients had negative emotions such as tension or anxiety and identified the causes, providing targeted psychological counseling. Patients were comforted by playing soothing music or guided through breathing relaxation exercises to help them become aware of physical changes during breathing, thereby relieving anxiety and stress. Nutrition nurses instructed patients to fast for 6 h and abstain from drinking for 2 h before surgery. Patients were allowed to consume residue-free fruit juice or 400 ml of 10% glucose solution 2 h before surgery to reduce hunger and lower the risk of postoperative insulin resistance. (3) Intraoperative Care: Limiting the standard fluid intake for patients in the observation group. If there was no significant bleeding, the fluid input was controlled at 500–1000 ml. Nursing staff closely monitored the patient’s position, implemented warmth preservation measures, and measured body temperature every hour for timely adjustment of warming methods. (4) Postoperative Care: ① After surgery, patients were allowed to chew gum to simulate feeding, aiding in the early recovery of intestinal function. ② Patients were advised to consume a diet rich in high protein, vitamins, high-calorie, and easily digestible foods postoperatively. ③ Patients were encouraged to engage in structured early mobilization: assisted sitting ≥ 60° in bed at 6 h postop, standing by bed at 24 h postop, and ambulating ≥ 50 m three times daily from 48 h postop, while maintaining suitable room temperature (24–26℃) and humidity (50–60%). ④ Systematic pain management was implemented using VAS assessment every 4 h, with patients comforted through non-pharmacological interventions (cold compress, acupressure), assisted positioning, and relaxation exercises (slow deep breathing, music, meditation); pain pumps were administered when necessary. ⑤ Depending on the patient’s condition, a targeted rehabilitation plan was developed to assist limb exercises, with discharge permitted only when meeting all criteria: no wound exudate for 24 h, VAS ≤ 3 at rest, and independent ambulation/feeding. ⑥ Nurses conducted regular assessments of the skin flap color at the surgical site, wound healing, and upper limb blood circulation, ensuring skin cleanliness. Any abnormalities were promptly reported to the attending physician. ⑦ Nursing staff used appropriate language to avoid patient distress and facilitated psychological adaptation, encouraging family accompaniment throughout. ⑧ Extended care services were provided for 14 days post-discharge, including rehab video tutorials and a 24-hour consultation hotline.

Observation parameters

1. Nursing Effectiveness: Nursing effectiveness was determined based on the patient’s therapeutic outcome, with the following criteria: Marked Effectiveness: Restoration of normal or nearly normal upper limb mobility and muscle strength > 4. Effectiveness: Significant improvement in upper limb mobility with muscle strength between 2 and 4. Ineffectiveness: Failure to meet the above criteria.

2. Postoperative Recovery: Postoperative recovery parameters observed in this study included time to get out of bed, drainage time, time to start eating, wound healing time, length of hospital stay, and pain levels. These parameters were uniformly recorded by relevant medical staff at our hospital. Pain levels were assessed using the Visual Analog Scale (VAS) [9], in which patients selected a numerical value between 0 and 10 to indicate the intensity of their pain, with higher values indicating greater pain. Incision Healing Time: It was independently assessed by two physicians using a blinded evaluation method. The criteria included: (1) complete epithelialization of the incision; (2) absence of redness, swelling, or exudate; and (3) no wound dehiscence within 24 h after suture removal. The healing time (in days) was recorded from the end of surgery to the point when all three criteria were met.

3. Serum Inflammatory Markers: Before and after intervention, 5 ml of fasting morning cubital vein blood samples were collected from patients, centrifuged to obtain serum, and sent for testing using enzyme-linked immunosorbent assay (ELISA). Serum levels of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and nuclear factor-kappa B (NF-κB) were determined.

4. Psychological Distress: [10] Before and after intervention, patient anxiety levels were assessed using the Self-Rating Anxiety Scale (SAS), which has a total score of 100 points, with a cutoff value of 50 points. Lower scores indicate lower levels of anxiety. Patient depression levels were assessed using the Self-Rating Depression Scale (SDS), which also has a total score of 100 points, with a cutoff value of 53 points. Lower scores indicate lower levels of internal depressive emotions.

5. Occurrence of Complications: Complications observed in this study included subcutaneous fluid accumulation, flap necrosis, upper limb edema, incision infection, and incision bleeding. The occurrence of these complications was uniformly recorded by relevant medical staff at our hospital.

Statistical analysis

GraphPad Prism 8 was used for graphical representation, and SPSS 22.0 was used for data analysis. For continuous data, means and standard deviations were used to describe their distribution, and statistical analysis was performed using t-tests or analysis of variance (ANOVA). For categorical data, frequencies and percentages were used to describe their distribution, and statistical analysis was conducted using chi-square tests or Fisher’s exact tests. A significance level of P < 0.05 was considered statistically significant.

Results

Comparison of baseline data

The baseline data of the two groups of patients were comparable, with no significant differences observed in the comparisons (P > 0.05). Refer to Table 1 for details.

Table 1.

Comparison of baseline data

	Control(n = 46)	Observation(n = 46)	t/x²	P
Age (years)	47.29 ± 6.38	48.05 ± 6.27	0.576	0.565
Duration of illness (years)	1.12 ± 0.53	1.05 ± 0.59	0.598	0.550
BMI(kg/m²)	25.82 ± 3.46	25.74 ± 3.61	0.108	0.913
Tumor diameter (cm)	2.82 ± 1.06	2.87 ± 0.98	0.234	0.814
Clinical stage			0.186	0.665
Stage I	18	16
Stage II	28	30

Comparison of nursing effectiveness

The nursing effectiveness in the control group was 80.43%, while in the observation group, it was 95.65%. The nursing effectiveness in the observation group was significantly higher than that in the control group (P < 0.05). Refer to Table 2 for details.

Table 2.

Comparison of nursing effectiveness

Group	n	Remarkable	Effective	Ineffective	Total Effectiveness (%)
Control	46	12	25	9	80.43%
Observation	46	17	27	2	95.65%
x²	-	-	-	-	5.059
P	-	-	-	-	0.024

Comparison of postoperative recovery

The observation group showed significantly shorter times for getting out of bed, drainage removal, time to start eating, incision healing, and hospital stay compared to the control group (P < 0.05). Refer to Table 3 for details.

Table 3.

Comparison of postoperative recovery

Perioperative Indicators	Control(n = 46)	Observation(n = 46)	t	P
Time to Get Out of Bed (h)	38.26 ± 9.45	24.39 ± 7.57	7.769	<0.001
Time of Drainage (d)	6.64 ± 2.37	5.23 ± 2.15	2.988	0.003
Time to Start Eating (h)	18.56 ± 4.32	13.22 ± 3.61 0.22	6.433	<0.001
Incision Healing Time (d)	9.57 ± 3.14	7.69 ± 2.08	3.385	0.001
Hospital Stay (d)	10.78 ± 2.76	7.89 ± 2.54	5.225	<0.001
Pain Level (score)	4.27 ± 0.36	2.39 ± 0.21	30.594	<0.001

Comparison of serum inflammatory factors

As shown in Fig. 1, in the control group, before and after intervention, IL-6 levels were (2.95 ± 0.83, 6.27 ± 2.46), TNF-α levels were (5.74 ± 1.51, 9.38 ± 3.52), and NF-κB levels were (23.68 ± 3.29, 58.79 ± 7.68). In the observation group, before and after intervention, IL-6 levels were (2.92 ± 0.85, 4.65 ± 1.64), TNF-α levels were (5.67 ± 1.48, 7.62 ± 2.16), and NF-κB levels were (23.65 ± 3.23, 43.39 ± 6.21). Before intervention, there were no significant differences in IL-6, TNF-α, and NF-κB levels between the two groups (P > 0.05). After intervention, the IL-6, TNF-α, and NF-κB levels in the observation group were significantly lower than those in the control group (P < 0.05).

Fig. 1.

Comparison of Serum Inflammatory Factors. Note: * indicates P < 0.05 in comparison

Comparison of psychological distress

As shown in Fig. 2, in the control group, before and after intervention, SAS scores were (54.73 ± 3.86, 48.65 ± 3.69), and SDS scores were (58.74 ± 5.32, 47.75 ± 3.56). In the observation group, before and after intervention, SAS scores were (54.15 ± 4.09, 40.43 ± 2.39), and SDS scores were (59.17 ± 5.21, 42.71 ± 2.83). Before intervention, there were no significant differences in SAS and SDS scores between the two groups (P > 0.05). After intervention, the SAS and SDS scores in the observation group were significantly lower than those in the control group (P < 0.05).

Fig. 2.

Comparison of Psychological Distress

Comparison of complication incidence

The complication incidence in the control group was 23.91%, while in the observation group, it was 8.70%. The complication incidence in the observation group was significantly lower than that in the control group (P < 0.05), as detailed in Table 4.

Table 4.

Comparison of complication incidence

Complication	Control(n = 46)	Observation(n = 46)	x²	P
Subcutaneous Fluid	2	0	-	-
Flap Necrosis	1	0	-	-
Upper Limb Edema	1	1	-	-
Incision Infection	3	1	-	-
Incision Bleeding	4	2	-	-
Total Incidence (%)	23.91%	8.70%	3.903	0.048

Discussion

Fast track surgery, also known as fast track surgical care or fast track surgical program, is an interdisciplinary medical model that provides comprehensive care for surgical patients [11]. This concept advocates the integrated use of various treatment measures such as fast-track anesthesia, minimally invasive techniques, optimal pain management techniques, promotion of intestinal function recovery, early postoperative ambulation, and early feeding to minimize surgical trauma, shorten postoperative recovery time, reduce the risk of complications, and thereby improve the postoperative quality of life of surgical patients [12]. Previously, fast track surgery was often applied in the perioperative period of gastrointestinal tumors, achieving significant results [13, 14]. However, the application of this concept in breast diseases requires further validation.

A study [15] has shown that breast cancer consistently ranks as the most common malignancy among women worldwide, with an increasing incidence trend in recent years in China. Currently, surgical procedures are the primary treatment for early-stage breast cancer, but patients may experience various postoperative complications, such as upper limb lymphedema, incision infection, flap necrosis, and local deformities, which can cause significant psychological and physical trauma to patients [16]. This highlights the need for enhanced perioperative care services for breast cancer patients in clinical practice. High-quality nursing interventions can reduce the risk of surgical complications and expedite patients’ recovery. In this study, we attempted to apply the concept of fast track surgery to the perioperative nursing of breast cancer patients. Previous research [17] has found that although breast-conserving surgery for breast cancer can preserve breast tissue to the greatest extent, it inevitably damages the lymphatic drainage pathway of the affected upper limb, leading to the possibility of upper limb swelling in some patients. Additionally, factors such as postoperative scar formation and wound pain can affect the function of the affected upper limb, primarily manifested as a reduced range of motion in the shoulder joint of the affected upper limb. Without timely rehabilitation training, this can potentially impact a patient’s daily life [18]. In this study, patients in the observation group received intervention based on the fast track surgery concept in addition to routine care provided to the control group. The results showed that the total nursing effectiveness rate in the control group was 80.43%, while in the observation group, it was 95.65%, significantly higher than that in the control group (P < 0.05). This surpasses the 89.2% efficacy reported by Chau et al. in their FTS trial for mastectomy patients [19], suggesting broader applicability of FTS in breast-conserving procedures. The observation group exhibited significantly shorter times for getting out of bed, drainage, time to eating, incision healing, and hospitalization, and experienced less pain compared to the control group (P < 0.05). These results align with Zhang et al.‘s report of 5.9-day stays in FTS-managed breast reconstruction [20], but our 23% reduction highlights efficiency gains in simpler procedures. After intervention, the levels of IL-6, TNF-α, and NF-κB in the observation group were significantly lower than those in the control group (P < 0.05). Notably, IL-6 levels (4.65 ± 1.64) were 31% lower than Wang et al.‘s FTS cohort [21], possibly due to our stricter pain control protocols. SAS/SDS scores decreased more substantially with FTS (P < 0.05). The SDS reduction (42.71 ± 2.83) parallels Motuziuk et al.‘s findings [22], confirming FTS mitigates surgical depression. The complication rate in the control group was 23.91%, while it was 8.70% in the observation group, with the observation group experiencing significantly fewer complications (P < 0.05). These results are consistent with previous studies [23] and collectively confirm that the application of the fast track surgery concept can effectively shorten the recovery time of patients and improve clinical treatment outcomes. The reasons for this may lie in the fact that the fast track surgery concept includes preoperative patient education, emphasizing the characteristics of the disease, and highlighting the current comprehensive treatment and prognosis advantages of breast cancer, helping patients build confidence in overcoming the disease. It also explains the potential complications of surgery, the importance of postoperative rehabilitation training, and provides specific instructions for rehabilitation exercises. Additionally, nurses trained in rehabilitation provide early rehabilitation training to patients. The fast track surgery concept helps patients overcome emotional lows, seizes the optimal period for rehabilitation, reduces adhesions in surrounding tissues, decreases the incidence of muscle atrophy around the shoulder joint, and ensures timely and comprehensive recovery of upper limb function on the affected side.

Although this study has yielded some valuable findings regarding the impact of applying the fast track surgery (FTS) concept to the perioperative care of breast cancer patients, there are still some limitations in the research. For example: ① Study Design: This study employed a retrospective analysis rather than a randomized controlled trial (RCT), which may introduce potential selection bias and information bias. ② Sample Size: The sample size in this study is relatively small, consisting of only 92 breast cancer patients, which may limit a comprehensive assessment of the effects and the accuracy of statistical analysis. ③ Study Duration: The data collection period for this study was relatively short, spanning only one year. The recovery and complications of breast cancer patients may require a longer assessment period. ④ Study Limitations: This study was limited to data from a single medical institution and may not fully represent other medical institutions or breast cancer patient populations in different regions. In summary, while this study provides initial insights into the application of the FTS concept in the perioperative care of breast-conserving surgery for breast cancer patients, the results should be interpreted with caution due to the aforementioned limitations. Future research should aim to address these limitations by increasing the sample size, adopting a randomized controlled trial design, considering more potential factors, and conducting longer-term follow-up to further explore this field.

Conclusion

The application of the fast track surgery (FTS) concept in the perioperative care of breast-conserving surgery for breast cancer patients has shown promising results. Compared to conventional nursing interventions, FTS-based nursing can further improve patient outcomes, mitigate the body’s inflammatory response, alleviate negative emotions, accelerate patient recovery, and reduce the risk of surgery-related complications. It is worthy of clinical promotion and application.

Author contributions

Yu-Ting Li contributed equally to the design and writing of the paper. Zhong-Ru Cao contributed to the experimental design.

Funding

This research did not receive funding.

Data availability

All data generated or analysed during this study are included in this published article.

Declarations

Ethical approval and consent to participate

This study was approved by the ethics committee of Harbin Medical University Cancer Hospital. Informed consent was obtained from all study participants. All the methods were carried out in accordance with the Declaration of Helsinki.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.