Effect of Comprehensive Noise Reduction Nursing on Pain Management and Quality of Life in Patients with T-tube Drainage after Choledocholithiasis Surgery

Abstract

Objective:

To investigate the effects of comprehensive noise reduction nursing on pain management and quality of life in patients with T-tube drainage after choledocholithiasis surgery.

Methods:

We retrospectively analysed 170 patients who underwent choledocholithiasis surgery with T-tube drainage between January 2023 and June 2025. Patients received either conventional nursing (n = 73) or comprehensive noise reduction nursing (n = 97). Outcomes included postoperative pain assessed using the Visual Analogue Scale (VAS), sleep quality assessed using the Pittsburgh Sleep Quality Index (PSQI), stress indicators (cortisol [COR] and norepinephrine [NE], T-tube-related complications, quality of life assessed using the 36-Item Short Form Health Survey (SF-36) and readiness for hospital discharge assessed using the Readiness for Hospital Discharge Scale (RHDS).

Results:

The noise reduction group showed significantly lower VAS scores on postoperative days 1, 3 and 7 (all P < 0.05). On postoperative day 7, the noise reduction group had better PSQI scores (except sleep medication use, P = 0.307) and lower serum COR and NE levels than the conventional nursing group (all P < 0.05). T-tube-related complications were fewer in the noise reduction group (9.28% vs. 21.92%, P < 0.05). Before discharge, the noise reduction group exhibited higher SF-36 scores in most dimensions (all P < 0.05), though differences in social functioning and role-emotional were not significant. RHDS scores were also significantly higher in the noise reduction group (all P < 0.05). Sensitivity analyses confirmed the robustness of the main findings, with no significant differences in baseline characteristics or perioperative management between the two study periods. In addition, a contemporaneous subgroup analysis (patients admitted after June 2024) demonstrated consistent results across most study endpoints.

Conclusion:

Comprehensive noise reduction nursing was associated with reduced postoperative pain, improved sleep quality, fewer T-tube-related complications and stress responses and better quality of life and discharge readiness in patients after choledocholithiasis surgery with T-tube drainage.

KEY MESSAGES

• (1)Comprehensive noise reduction nursing is associated with reduced postoperative pain and improved sleep quality in patients with T-tube drainage after choledocholithiasis surgery.
• (2)This nursing strategy is associated with fewer T-tube-related complications and attenuates the systemic stress response.
• (3)Patients receiving comprehensive noise reduction nursing may have better quality of life and greater readiness for hospital discharge.

INTRODUCTION

Choledocholithiasis is a common biliary tract disorder encountered in hepatobiliary surgery, accounting for approximately 5%–25% of biliary calculi cases. In clinical practice, common bile duct exploration with stone extraction combined with T-tube drainage is a widely used treatment.[1] T-tube drainage effectively facilitates bile drainage, reduces biliary pressure and helps prevent postoperative bile leakage and biliary stricture, thereby playing a crucial role in ensuring surgical outcomes and promoting patient recovery.[2] However, patients require a prolonged postoperative T-tube retention. Owing to factors such as surgical trauma, catheter-related irritation and restricted mobility, these patients are susceptible to varying degrees of somatic pain and psychological stress.

In addition, persistent ward noise, including monitor alarms, staff conversations and operational sounds, can induce continuous acoustic stimulation.[3] Previous studies have demonstrated that noise levels in ward environments frequently exceed the standards recommended by international organisations, which may disrupt circadian rhythms, activate the hypothalamic–pituitary–adrenal (HPA) axis, enhance sympathetic nervous system activity and alter postoperative pain perception thresholds, consequently impeding postoperative recovery.[4]

Currently, postoperative pain and sleep management predominantly rely on pharmacologic analgesia and routine nursing care. However, analgesic medications carry potential risks of dependence, whereas routine nursing care primarily focuses on catheter maintenance, disease condition monitoring and symptomatic pain relief, with insufficient attention paid to environmental noise within the ward. Consequently, these approaches may inadequately address the comprehensive nursing needs of patients.[5]

Comprehensive noise reduction nursing is a patient-centred, multidimensional nursing strategy that integrates environmental noise reduction, operational noise minimisation and psychological support. By optimising ward environment, standardising personnel behavioural protocols and implementing individualised psychological support, this approach aims to reduce patients’ exposure to environmental noise and enhance their capacity to cope with environmental stressors.[6] However, studies investigating the effects of comprehensive noise reduction nursing on pain, stress responses and sleep quality in patients with T-tube drainage after choledocholithiasis surgery remain limited.

Therefore, this study retrospectively analysed the clinical data of 170 patients with T-tube drainage following choledocholithiasis surgery, with the objective of exploring the effects of comprehensive noise reduction nursing on pain alleviation, improvement in quality of life and enhancement of recovery outcomes, thereby providing a reference for the optimisation of clinical nursing protocols.

MATERIALS AND METHODS

Study Subjects

A total of 218 patients who underwent choledocholithiasis surgery with postoperative T-tube drainage in the Department of Hepatobiliary Surgery at Fuyang People’s Hospital between January 2023 and June 2025 were initially screened. Of these, 48 patients were excluded according to the following criteria: 12 had severe hepatic or renal insufficiency or malignant tumours of the biliary system; eight had psychiatric disorders or cognitive impairment; six had a history of long-term analgesic dependence; five had other severe biliary tract diseases; seven were transferred to the intensive care unit (ICU) after surgery; 10 had pre-existing sleep disorders.

Group assignment was determined according to ward location. Comprehensive noise reduction nursing measures was implemented in the east wing wards beginning in June 2024, whereas routine care continued in the west wing wards. Patients admitted to the east wing after June 2024 were assigned to the noise reduction group (n = 97), and those admitted to the west wing were assigned to the conventional group (n = 73). Apart from the noise reduction nursing measures, the baseline conditions of ward environments in both groups, including architectural layout, bed density and healthcare staff allocation, remained consistent during the study period.

This study was approved by the Medical Ethics Committee of Fuyang People’s Hospital (Approval number: Medical Ethics Review [2026] No. 73), and all study procedures were conducted in compliance with the relevant requirements of the Declaration of Helsinki.[7] Written informed consent was obtained from all patients or their legal guardians prior to their inclusion.

Inclusion criteria included the following: ① diagnosis of choledocholithiasis confirmed by preoperative imaging examinations and intraoperative findings; ② treatment with laparoscopic or open common bile duct exploration combined with T-tube drainage; ③ postoperative T-tube indwelling duration for ≥7 days (to ensure complete collection of stress indicator data during hospitalisation); ④ complete clinical data; ⑤ clear consciousness with the ability to communicate and comprehend.

Exclusion criteria included the following: ① severe hepatic or renal insufficiency or malignant tumours of the biliary system; ② psychiatric disorders or cognitive impairment; ③ history of long-term analgesic dependence prior to admission; ④ other severe biliary tract diseases; ⑤ postoperative transfer to the ICU; ⑥ pre-existing sleep disorder (pre-admission Pittsburgh Sleep Quality Index [PSQI] score ≥7 or a clear medical record diagnosis of insomnia).

Nursing Methods

Patients in the conventional group received routine postoperative nursing care following hepatobiliary surgery, including vital signs monitoring, T-tube stabilisation and drainage care, routine pain assessment and symptomatic management, medication guidance, dietary nursing and health education related to the disease and catheter maintenance.

In addition to the routine care described above, patients in the noise reduction group received comprehensive noise reduction nursing measures, which comprised the following components:

① Environmental noise reduction: Patients were provided with noise-reducing earplugs or noise-cancelling headphones (selected according to patient preference) and were instructed to wear these devices during daytime rest periods and nighttime sleep. The earplugs and headphones were managed centrally by the department. After each use, the surfaces of the earplugs and headphones were wiped and disinfected with 75% ethanol cotton balls or chlorine-containing disinfectant wipes, allowed to air dry and subsequently stored in a clean container to prevent cross-infection.

② Behavioral noise reduction: Healthcare personnel strictly adhered to behavioral protocols emphasising speaking softly, walking gently, performing procedures quietly and closing doors softly. Between 22:00 and 06:00, the main ward lights were turned off, leaving only low-intensity bedside nightlights on. Non-emergent therapeutic and nursing procedures were scheduled during daytime hours, and emergency procedures were performed with minimal acoustic disturbance. Noise reduction education was provided to both patients and their families, including restrictions on the number of visitors and the duration of visits. Loud conversations and the use of external speakers on electronic devices were strictly prohibited within the ward.

③ Equipment noise reduction: Medical equipment, including monitors and infusion pumps, was adjusted to night mode, with alarm volumes set to the minimum effective level. Dedicated personnel were assigned to regularly inspect the operational status of the equipment and to promptly address abnormal alarms, thereby preventing continuous noise generation from false or unnecessary alarms.

The nursing period extended from the day of surgery to the day of patient discharge.

Noise Monitoring Methods[8]: During hospitalisation, ward noise levels were measured by uniformly trained nurses using a calibrated sound level meter (Model: TES-1350A, TES Electrical Electronic Corp., Taipei, Taiwan). The measurement periods included daytime (06:00–22:00) and nighttime (22:00–06:00 the following day). The equivalent continuous A-weighted sound pressure level (LAeq) was recorded for 5 minutes every hour. Measurements were taken at the bedside, approximately 0.5 m from the patient’s ear. Monitoring was conducted continuously from postoperative day 1 to postoperative day 7. Daily mean daytime and nighttime LAeq values were calculated for analysis. All data were recorded in a dedicated database by assigned personnel, and the measurement time, location and equipment status were verified daily.

Data Collection

All outcome data were extracted from the hospital electronic medical record and nursing documentation systems. The timing of data collection corresponded to the actual assessment or measurement time recorded during the patients’ hospitalisation.

Baseline assessments were performed before the initiation of nursing care on the day of surgery (hereafter referred to as “before nursing”). Specifically, the PSQI was completed upon admission to assess sleep quality over the preceding month; blood samples for stress indicators were collected preoperatively on the morning of surgery; and the 36-Item Short Form Health Survey (SF-36) was completed within 24 hours of admission. All baseline assessments were completed prior to the implementation of any study-related nursing measures.

Outcome Measures

Baseline Characteristics

Baseline data and perioperative clinical characteristics were extracted from the medical records during hospitalisation, including sex, age, body mass index (BMI), comorbidities (hypertension and diabetes mellitus), number of calculi, maximum calculus diameter, presence of concomitant acute cholangitis, preoperative jaundice, preoperative total bilirubin and postoperative T-tube indwelling duration.

Pain Intensity

Pain intensity was assessed using the Visual Analogue Scale (VAS) scores on postoperative days 1, 3 and 7.[9] The VAS score ranges from 0 to 10, with higher scores indicating greater pain intensity. The VAS has demonstrated good reliability and validity in postoperative pain assessment, with test–retest reliability coefficients ranging from 0.73 to 0.84.

Sleep Quality

Sleep quality was evaluated on postoperative day 7 using the PSQI scores.[10] The PSQI comprises seven components: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication and daytime dysfunction. Each component is scored on a scale of 0–3, yielding a total score ranging from 0 to 21, with higher scores indicating poorer sleep quality. The PSQI has demonstrated high test–retest reliability and good validity, with a total score >5 yielding a sensitivity of 98.7% and a specificity of 84.4%.

T-tube-Related Complications

The occurrence of T-tube-related complications, including T-tube dislodgement, obstruction, bile leakage and biliary tract infection during hospitalization was extracted from the patients’ medical records, and the overall incidence was calculated.

Stress Indicators

Serum cortisol (COR) and norepinephrine (NE) levels before nursing and on postoperative day 7 were extracted from the patients’ medical records during hospitalisation.

Quality of Life

Quality of life was assessed using the SF-36 scores before nursing and prior to discharge.[11] The SF-36 comprises eight dimensions: physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional and mental health. Each dimension is scored on a scale of 0–100, with higher scores reflecting better quality of life.

Readiness for Hospital Discharge

The assessment results of the Readiness for Hospital Discharge Scale (RHDS) were extracted from the medical record. The RHDS was originally developed by Weiss and Piacentin.[12] The present study used the Chinese version of the RHDS (RHDS_C), which was translated and validated by Chen et al.[13] Confirmatory factor analysis of the RHDS_C revealed a three-factor structural model, comprising three dimensions: personal status (3 items), coping ability (5 items) and expected support (4 items), for a total of 12 items. Each item is scored on a scale of 0 to 10, where 0 indicates “not at all ready” and 10 indicates “completely ready.” The total score ranges from 0 to 120, with higher scores reflecting better readiness for hospital discharge. The Cronbach’s α for the overall scale was 0.89, and α values for the three dimensions were 0.73, 0.90 and 0.89, respectively. The scale was assessed on the day of discharge and prior to the completion of discharge procedures. All data were recorded in the nursing documentation system.

Statistical Methods

Statistical analyses were performed using SPSS version 26.0 software (IBM Corp., Armonk, NY, USA). The normality of continuous variables was assessed using the Shapiro–Wilk test. Data conforming to a normal distribution are presented as mean ± standard deviation (x̄±s) and were compared using the independent samples t-test; data not conforming to a normal distribution were presented as median (interquartile range) and were compared using the Mann–Whitney U test. For VAS scores measured repeatedly on postoperative day 1, 3 and 7, a repeated-measures analysis of variance (ANOVA) was performed with group (noise reduction vs. conventional) as the between-subject factor and time (postoperative day 1, 3 and 7) as the within-subject factor. The sphericity assumption was tested using Mauchly’s test, and the Greenhouse–Geisser correction was applied when necessary. When a significant group × time interaction was detected, post-hoc pairwise comparisons were performed using the Bonferroni correction. For comparisons between two groups at a single time point, the independent samples t-test was used. Categorical data were presented as frequency (percentage) [n (%)] and were compared using the chi-squared test. Sensitivity analyses were performed to assess potential temporal confounding by comparing baseline characteristics and perioperative management between patients admitted in Period 1 (January 2023–May 2024) and Period 2 (June 2024–June 2025) using independent samples t-tests for continuous variables and chi-squared tests for categorical variables. A contemporaneous subgroup analysis was further conducted among patients admitted after June 2024 to validate the main findings within a homogeneous temporal cohort. A P-value of <0.05 was considered statistically significant.

RESULTS

Comparison of Baseline Data

No significant between-group differences were observed in baseline data, including sex, age, BMI, comorbidities, stone-related variables and perioperative clinical characteristics (all P > 0.05), indicating that the two groups were comparable [Table 1].

Table 1.

Comparison of baseline data between the two groups

Variable	Noise reduction group (n = 97)	Conventional group (n = 73)	t/χ2	P
Sex (male/female)	57 (58.76)/40 (41.24)	38 (52.05)/35 (47.95)	0.760	0.383
Age (years)	52.37 ± 11.24	51.52 ± 10.96	0.493	0.623
BMI (kg/m2)	23.15 ± 2.47	22.39 ± 2.53	1.965	0.051
Comorbid hypertension	27 (27.84)	15 (20.55)	1.189	0.276
Comorbid diabetes mellitus	21 (21.65)	11 (15.07)	1.181	0.277
Number of calculi	2.47 ± 1.21	2.33 ± 1.18	0.756	0.451
Maximum calculus diameter (mm)	11.82 ± 4.35	12.14 ± 4.62	0.463	0.644
Concomitant acute cholangitis	32 (32.99)	21 (28.77)	0.347	0.556
Preoperative jaundice	41 (42.27)	29 (39.73)	0.111	0.739
Preoperative total bilirubin (μmol/L)	28.36 ± 9.47	27.52 ± 9.12	0.582	0.561
Postoperative T-tube indwelling duration (d)	13.03 ± 3.28	12.27 ± 3.41	1.470	0.143

Notes: BMI, body mass index. Postoperative T-tube indwelling duration during hospitalisation refers to the period from the day of surgery to the day of discharge during which the patient retained the T-tube. The total duration of T-tube retention (including the period after discharge) is typically 4–8 weeks. The duration recorded in this study pertains exclusively to the indwelling period during hospitalisation. This table presents the baseline comparison for the primary analysis between the noise reduction and conventional groups.

Comparison of Postoperative Pain Intensity

The postoperative VAS scores in both groups exhibited a decreasing trend over time. Repeated-measures ANOVA revealed a significant main effect of group (F = 6.127, P = 0.014), a significant main effect of time (F = 712.614, P < 0.001) and a significant group × time interaction (F = 4.382, P = 0.013), indicating that the reduction in pain scores over time differed between the two groups. Bonferroni post-hoc comparisons for within-group comparisons across time points showed that in both groups, VAS scores on postoperative days 3 and 7 were significantly lower than those on postoperative day 1 (all P < 0.05) and scores on postoperative day 7 were also significantly lower than those on postoperative day 3 (all P < 0.05). For between-group comparisons at each time point, independent samples t-tests were applied, which revealed that VAS scores in the noise reduction group were significantly lower than those in the conventional group on postoperative days 3 and 7 (both P < 0.05), while no significant between-group difference was observed on postoperative day 1 (P = 0.299) [Table 2].

Table 2.

Comparison of postoperative VAS pain scores at different time points between the two groups (score, x̄±s)

Group	1d after surgery	3d after surgery	7d after surgery	Repeated-measures ANOVA
Noise reduction group (n = 97)	6.28 ± 1.45	3.76 ± 1.08*	1.83 ± 0.82*#	Group: F = 6.127, P = 0.014
Conventional group (n = 73)	6.52 ± 1.50	4.59 ± 1.24*	2.35 ± 0.97*#	Time: F = 712.614, P < 0.001
Between-group comparison	t = 1.042	t = 4.638	t = 3.676	Group × Time: F = 4.382, P = 0.013
	P = 0.299	P < 0.001	P < 0.001

Notes: *P < 0.05 compared with postoperative day 1 within the same group (Bonferroni post-hoc); #P < 0.05 compared with postoperative day 3 within the same group (Bonferroni post-hoc). Between-group comparisons at each time point were performed using independent samples t test. Mauchly’s test of sphericity: W = 0.982, P = 0.173, indicating that the sphericity assumption was met. ANOVA, analysis of variance; SD, standard deviation; VAS, Visual Analogue Scale.

Comparison of Postoperative Sleep Quality

On postoperative day 7, the component scores and the total score of the PSQI were significantly decreased in both groups compared with those before nursing (all P < 0.05). For the component of use of sleeping medication, no significant difference was found between the two groups on postoperative day 7 (P = 0.307). For other components and the total score, the noise reduction group showed significantly lower scores than the conventional group (all P < 0.05) [Table 3].

Table 3.

Comparison of postoperative PSQI scores between the two groups (score, x̄±s)

PSQI components	Time point	Noise reduction group (n = 97)	Conventional group (n = 73)	t	P
Subjective sleep quality	Before nursing	1.89 ± 0.54	1.92 ± 0.56	0.353	0.724
	7 d postoperatively	1.48 ± 0.47*	1.72 ± 0.50*	3.211	0.002
Sleep latency	Before nursing	1.96 ± 0.58	1.94 ± 0.55	0.227	0.821
	7 d postoperatively	1.55 ± 0.51*	1.78 ± 0.53*	2.867	0.005
Sleep duration	Before nursing	1.82 ± 0.49	1.85 ± 0.51	0.388	0.699
	7 d postoperatively	1.47 ± 0.42*	1.70 ± 0.46*	3.394	0.001
Habitual sleep efficiency	Before nursing	1.51 ± 0.43	1.47 ± 0.45	0.588	0.557
	7 d postoperatively	0.99 ± 0.36*	1.25 ± 0.39*	4.503	<0.001
Sleep disturbances	Before nursing	1.62 ± 0.45	1.59 ± 0.47	0.422	0.674
	7 d postoperatively	1.16 ± 0.39*	1.40 ± 0.42*	3.847	<0.001
Use of sleep medication	Before nursing	0.42 ± 0.21	0.38 ± 0.23	1.179	0.240
	7 d postoperatively	0.23 ± 0.18*	0.26 ± 0.20*	1.026	0.307
Daytime dysfunction	Before nursing	1.79 ± 0.51	1.76±0.49	0.386	0.700
	7 d postoperatively	1.22 ± 0.43*	1.58 ± 0.46*	5.252	<0.001
Total score	Before nursing	11.01 ± 3.21	10.91±3.26	0.200	0.842
	7 d postoperatively	8.10±2.76*	9.69±2.91*	3.645	<0.001

Notes: *P < 0.05 compared with before nursing within the same group. PSQI, Pittsburgh Sleep Quality Index.

Comparison of Postoperative Stress Indicator Levels

On postoperative day 7, serum COR and NE levels in the noise reduction group were significantly decreased compared with those before nursing measures (all P < 0.05), whereas serum COR and NE levels in the conventional group were significantly elevated compared with those before nursing measures (all P < 0.05). Furthermore, serum COR and NE levels on postoperative day 7 in the noise reduction group were significantly lower than those in the conventional group (all P < 0.05) [Table 4].

Table 4.

Comparison of postoperative stress indicators between the two groups (x̄±s)

Indicator	Time point	Noise reduction group (n = 97)	Conventional group (n = 73)	t	P
COR (nmol/L)	Before nursing	389.42 ± 45.36	385.71 ± 46.28	0.523	0.602
	7 d postoperatively	358.57 ± 42.69*	417.23 ± 48.52*	8.361	<0.001
NE (pg/mL)	Before nursing	351.86 ± 38.24	348.63 ± 39.51	0.537	0.592
	7 d postoperatively	306.34 ± 37.42*	372.19 ± 41.36*	10.853	<0.001

Notes: *P < 0.05 compared with before nursing within the same group. COR, cortisol; NE, norepinephrine.

Comparison of the Incidence of T-tube-Related Complications

The overall incidence of T-tube-related complications in the noise reduction group was 9.28%, which was significantly lower than 21.92% in the conventional group (P < 0.05) [Table 5].

Table 5.

Comparison of the incidence of T-tube-related complications between the two groups [n (%)]

Complication	Noise reduction group (n = 97)	Conventional group (n = 73)	χ2	P
T-tube out	0 (0.00)	1 (1.37)
T-pipe blockage	2 (2.06)	5 (6.85)
Bile leakage	6 (6.19)	8 (10.96)
Biliary tract infection	1 (1.03)	2 (2.74)
Overall occurrence	9 (9.28)	16 (21.92)	5.305	0.021

Notes: Statistical tests for individual complication types were not performed due to small sample sizes.

Comparison of Quality of Life before Discharge

Before discharge, all dimension scores of the SF-36 were significantly increased in both groups compared with those before nursing measures (all P < 0.05). In the between-group comparison before discharge, the noise reduction group demonstrated significantly higher scores than the conventional group for physical functioning, role-physical, bodily pain, general health, vitality and mental health (all P < 0.05). No significant between-group differences were found in dimension scores of social functioning (P = 0.087) and role-emotional (P = 0.114) [Table 6].

Table 6.

Comparison of SF-36 quality of life scores before discharge between the two groups (score, x̄±s)

Dimension	Time point	Noise reduction group (n = 97)	Conventional group (n = 73)	t	P
Physiological function	Before nursing	65.83 ± 9.12	66.21 ± 8.94	0.271	0.787
	Before discharge	74.26 ± 8.43*	69.85 ± 8.78*	3.321	0.001
Role-physical	Before nursing	61.54 ± 10.27	62.03 ± 9.86	0.313	0.755
	Before discharge	70.39 ± 9.25*	65.76 ± 9.50*	3.203	0.002
Somatic pain	Before nursing	71.26 ± 9.43	72.08 ± 9.15	0.568	0.571
	Before discharge	82.17 ± 7.68*	76.42 ± 8.21*	4.697	<0.001
Overall health	Before nursing	62.48 ± 8.76	63.15 ± 8.52	0.499	0.618
	Before discharge	71.54 ± 8.12*	66.93 ± 8.35*	3.630	<0.001
Vitality	Before nursing	60.32 ± 9.58	61.04 ± 9.27	0.492	0.624
	Before discharge	74.28 ± 8.76*	65.89 ± 9.02*	6.119	<0.001
Social function	Before nursing	65.41 ± 9.03	66.18 ± 8.79	0.557	0.578
	Before discharge	72.36 ± 8.24*	70.14 ± 8.51*	1.719	0.087
Emotional function	Before nursing	63.27 ± 10.15	64.02 ± 9.88	0.483	0.630
	Before discharge	70.15 ± 9.06*	67.88 ± 9.45*	1.590	0.114
Mental health	Before nursing	62.19 ± 9.47	62.86 ± 9.23	0.462	0.645
	Before discharge	73.82 ± 8.59*	65.93 ± 9.01*	5.811	<0.001

Notes: Compared with the same group before care *P < 0.05; SF-36, 36-Item Short Form Health Survey.

Comparison of Readiness for Hospital Discharge before Discharge

The scores for each dimension and the total score of the RHDS in the noise reduction group were significantly higher than those in the conventional group (all P < 0.05) [Table 7]

Table 7.

Comparison of RHDS scores before discharge between the two groups (score, x̄±s)

Dimension	Noise reduction group (n = 97)	Conventional group (n = 73)	t	P
Personal status (3 items)	28.96 ± 4.48	25.24 ± 4.32	5.442	<0.001
Coping ability (5 items)	38.80 ± 5.04	33.08 ± 4.76	7.500	<0.001
Expected support (4 items)	31.04 ± 5.24	26.60 ± 4.96	5.595	<0.001
Total score (12 items)	98.80 ± 12.60	84.92 ± 11.76	7.314	<0.001

Notes: RHDS, Readiness for Hospital Discharge Scale.

Comparison of Noise Exposure Levels during Hospitalisation

The daytime and nighttime noise levels in the noise reduction group were significantly lower than those in the conventional group (P < 0.001) [Table 8].

Table 8.

Comparison of daytime and nighttime noise levels during postoperative hospitalisation between the two groups [dB(A), x̄±s]

Period of time	Noise reduction group (n = 97)	Conventional group (n = 73)	t	P
Daytime noise	52.36 ± 3.18	59.42 ± 3.54	13.70	<0.001
Night noise	41.27 ± 2.93	49.85 ± 3.26	17.98	<0.001

Note: dB(A), A-weighted decibels.

Sensitivity Analyses

To assess potential temporal confounding, baseline characteristics and perioperative management were compared between patients admitted during Period 1 (Jan 2023–May 2024, n = 82) and Period 2 (Jun 2024–Jun 2025, n = 88). As shown in Table 9, no significant differences were observed between the two periods (all P > 0.05).

Table 9.

Comparison of baseline characteristics and perioperative management between Period 1 and Period 2

Variable	Period 1 (n = 82)	Period 2 (n = 88)	t/χ2	P
Sex (male/female)	45 (54.88)/37 (45.12)	50 (56.82)/38 (43.18)	0.065	0.799
Age (years)	51.88 ± 10.95	52.17 ± 11.31	0.171	0.864
BMI (kg/m2)	22.68 ± 2.51	22.95 ± 2.59	0.690	0.491
Comorbid hypertension	19 (23.17)	23 (26.14)	0.207	0.649
Comorbid diabetes mellitus	14 (17.07)	18 (20.45)	0.321	0.571
Number of calculi	2.38 ± 1.19	2.45 ± 1.22	0.379	0.705
Max. calculus diameter (mm)	11.95 ± 4.48	11.98 ± 4.51	0.044	0.965
Concomitant acute cholangitis	25 (30.49)	28 (31.82)	0.035	0.852
Preoperative jaundice	33 (40.24)	37 (42.05)	0.059	0.808
Preop. total bilirubin (μmol/L)	28.01 ± 9.28	27.95 ± 9.41	0.042	0.967
Surgical approach (Lap/Open)	68 (82.93)/14 (17.07)	74 (84.09)/14 (15.91)	0.042	0.838
Operation time (min)	142.56 ± 25.37	145.12 ± 26.14	0.647	0.519
Intraoperative blood loss (mL)	85.42 ± 28.56	88.13 ± 30.21	0.607	0.545
Postop. T-tube indwelling (d)	12.65 ± 3.35	12.75 ± 3.42	0.193	0.847

Notes: BMI, body mass index; Lap, laparoscopic; Max., maximum; Open, open surgery; Postop., postoperative; Preop., preoperative; SD, standard deviation. Data are presented as n (%) or mean ± SD. Period 1: Jan 2023–May 2024; Period 2: Jun 2024–Jun 2025. No significant differences were observed (all P > 0.05).

A contemporaneous subgroup analysis was further performed, restricted to patients admitted during Period 2, comprising the noise reduction group (n = 97) and a conventional subgroup (n = 15). As presented in Table 10, these results were consistent with the main findings, with the noise reduction group showing significantly better outcomes across most endpoints (all P < 0.05), except for VAS on postoperative day 1 (P = 0.067) and SF-36 social functioning and role-emotional dimensions (both P > 0.05).

Table 10.

Contemporaneous subgroup analysis (patients admitted after June 2024)

Outcome	Noise reduction (n = 97)	Conventional (n = 15)	t/χ2	P
VAS
1d postop	5.82 ± 1.37	6.53 ± 1.48	1.853	0.067
3d postop	3.76 ± 1.08	4.67 ± 1.21	3.032	0.003
7d postop	1.83 ± 0.82	2.40 ± 0.94	2.452	0.016
PSQI total (7d)	8.10 ± 2.76	9.87 ± 2.94	2.318	0.022
COR (nmol/L, 7d)	358.57 ± 42.69	421.56 ± 49.37	5.276	<0.001
NE (pg/mL, 7d)	306.34 ± 37.42	378.52 ± 42.15	6.830	<0.001
Complications (Overall)	9 (9.28)	4 (26.67)	4.189	0.041
SF-36 (pre-discharge)
Physical functioning	74.26 ± 8.43	69.52 ± 8.81	2.048	0.043
Role-physical	70.39 ± 9.25	65.48 ± 9.62	1.930	0.057
Bodily pain	82.17 ± 7.68	75.86 ± 8.35	2.955	0.004
General health	71.54 ± 8.12	66.57 ± 8.44	2.244	0.027
Vitality	74.28 ± 8.76	65.52 ± 9.18	3.680	<0.001
Social functioning	72.36 ± 8.24	69.87 ± 8.62	1.111	0.269
Role-emotional	70.15 ± 9.06	67.52 ± 9.53	1.047	0.298
Mental health	73.82 ± 8.59	65.58 ± 9.12	3.542	0.001
RHDS total	98.80 ± 12.60	84.12 ± 11.85	4.264	<0.001

Notes: COR, cortisol; NE, norepinephrine; PSQI, Pittsburgh Sleep Quality Index; RHDS, Readiness for Hospital Discharge Scale; SD, standard deviation; SF-36, 36-Item Short Form Health Survey; VAS, Visual Analogue Scale.

DISCUSSION

The present study showed that comprehensive noise reduction nursing was associated with reduced pain intensity, improved sleep quality, a lower incidence of T-tube-related complications, an attenuated systemic stress response and enhanced quality of life and readiness for hospital discharge in patients with T-tube drainage following choledocholithiasis surgery. These findings suggest that incorporating comprehensive noise reduction nursing measures, including environmental, behavioural and equipment-based interventions, into routine nursing care may facilitate postoperative recovery across multiple dimensions.

In the present study, VAS scores on postoperative days 3 and 7 in the noise reduction group were significantly lower than those in the conventional group, with no significant difference observed on postoperative day 1, suggesting that comprehensive noise reduction nursing may be associated with a sustained analgesic effect. Previous research has demonstrated a positive correlation between noise exposure during the postoperative emergence period and the intensity of acute pain, with environmental noise increasing pain sensitivity.[14] Similarly, a study of laparoscopic surgery reported lower postoperative pain scores in patients who were provided with sound-insulating earmuffs to isolate environmental noise.[15] In the present study, individualised noise protection was afforded to patients through the provision of noise-reducing earplugs or noise-cancelling headphones, which was further augmented by behavioural noise reduction protocols implemented by healthcare staff. Consequently, patient exposure to environmental noise was diminished, and a sustained pain-relieving effect was observed.

The present study further showed that the PSQI component scores and total score on postoperative day 7 were significantly lower in the noise reduction group than in the conventional group, suggesting that comprehensive noise reduction nursing may be associated with improvements in patient sleep quality. Postoperative sleep is influenced by multiple factors, among which ward noise represents a significant yet frequently overlooked source of disturbance. Shen et al.[16] analysed influencing factors of sleep quality in postoperative urological patients and verified a significant negative correlation between sleep quality and ward noise exposure levels, with nighttime noise showing a particularly prominent adverse effect. A systematic review by Xie et al.[17] concluded that environmental noise management in ICUs improved patients’ sleep quality and reduced physiological stress responses, consistent with the findings of the present study. However, previous investigations have predominantly focused on ICUs or disease-specific wards, and the management strategies employed have often been relatively singular, lacking systematic integration of environmental modifications with staff behavioural management. In contrast, the noise reduction group in the present study received multifaceted noise-control measures, such as nighttime equipment mode adjustments, standardisation of personnel conduct and visitation management, which may have reduced nighttime noise exposure and created a more conducive sleep environment for patients.

Despite the significant reduction in nighttime noise levels achieved in the noise reduction group (41.27 ± 2.93 dB), the mean LAeq remained above the World Health Organization (WHO)-recommended indoor guideline value of 30 dB for hospital wards. This observation highlights the challenge of achieving guideline-recommended noise levels in routine ward settings, where multiple unavoidable noise sources (e.g., monitor alarms from neighbouring beds, staff communication and equipment operation) are present. Additionally, the present study reported only LAeq as the noise metric. Future studies incorporating peak-noise indicators (e.g., Lamax) may provide a more comprehensive assessment of patients’ acoustic exposure and its relationship with sleep quality and recovery outcomes, as transient high-intensity noise events may have a disproportionate impact on sleep arousal and stress responses.

In the present study, serum COR and NE levels on postoperative day 7 in the noise reduction group were lower than those in the conventional group, thereby suggesting an association between stress levels and noise reduction measures. Unlike previous studies, which have largely focused on the subjective perceptions of patients regarding noise reduction nursing and have predominantly been conducted in ICU environments, the present study extended the implementation of noise reduction nursing to a general ward setting and incorporated objective laboratory indicators. As an environmental stressor, noise can activate the HPA axis and increase sympathetic excitability. A systematic review by Mendonça et al.[18] concluded that environmental modifications, including noise reduction protocols, were associated with improved sleep quality and reduced physiological stress responses in postoperative patients. It has been reported that persistent environmental noise exposure may elevate stress hormone levels, exacerbate systemic inflammatory and stress responses and delay postoperative recovery. Conversely, a decreasing trend in COR has been observed following noise exposure reduction through targeted management.[19] These findings are consistent with the results of the present study.

The selection of postoperative day 7 as the time point for stress indicator measurement in this study was based on the following considerations. First, the postoperative stress response exhibits dynamic changes. Previous research has indicated that stress hormones such as cortisol peak on postoperative day 1 and subsequently decline gradually; thus, postoperative day 7 represents a critical temporal juncture for evaluating the recovery trajectory of the stress response. Second, the typical duration of hospitalisation for patients treated by choledocholithiasis surgery ranges from approximately 7 to 14 days. On postoperative day 7, patients remain in hospital, facilitating uniform data collection and enabling assessment of the short-term effects of noise reduction nursing. Furthermore, by postoperative day 7, patients have generally passed through the acute stress period. The measurement of stress indicators at this time point reflects the cumulative impact of noise reduction nursing on systemic stress recovery rather than merely capturing the transient stress elevation attributable solely to surgical trauma.

Concurrently, the overall incidence of T-tube-related complications in the noise reduction group was significantly lower than that in the conventional group. This reduction in complications may be attributable to the combined effects of reduced pain, improved sleep quality and attenuation of the postoperative stress levels. With diminished discomfort, patients exhibited fewer position changes, resulting in reduced traction and irritation to the T-tube, thereby decreasing the occurrence of complications, such as dislodgement and obstruction. In contrast, the difference in the incidence of bile leakage between the two groups was relatively small, which may be ascribed to the fact that bile leakage is primarily influenced by surgical technique and biliary tract healing, factors that are less likely to be affected by noise reduction management.

The SF-36 dimension scores for physical functioning, role-physical, bodily pain, general health, vitality and mental health, as well as the RHDS dimension scores and the total score before discharge, were higher in the noise reduction group than in the conventional group. A cross-sectional study by Hamad et al.[20] investigating perceptions of music and noise in the operating room reported that healthcare professionals and patients identified noise reduction as a key factor influencing comfort levels, supporting the potential value of comprehensive noise management strategies in clinical settings. These findings suggest that the benefits of comprehensive noise reduction nursing may extend to the discharge phase. Patients not only experienced an enhanced recovery trajectory during hospitalisation but also exhibited improved disease-related knowledge acquisition, self-coping capacity and readiness for reintegration into family and society. Clinical research has shown that readiness for hospital discharge following abdominal surgery is directly correlated with the speed of postoperative recovery and hospital readmission rates. A comfortable inpatient environment and favourable physical and psychological status can substantially elevate patients’ readiness for discharge.[21] In the present study, the continuous implementation of noise reduction nursing throughout the entire hospitalisation period may have contributed to improved physical and psychological well-being, thereby enhancing patients’ readiness for hospital discharge.

The present study has several limitations. First, the study population was derived from a single centre, and the retrospective design introduces potential confounding factors and limits the generalisability of the findings. Second, given that comprehensive noise reduction nursing encompasses multiple interventions, including environmental modifications, personnel behavioural protocols and equipment adjustments, it is challenging to delineate the independent contribution of each individual component. Additionally, this study focused exclusively on the inpatient period, and the long-term effects of noise reduction nursing remain to be elucidated. Future prospective randomised controlled trials incorporating long-term follow-up are warranted to comprehensively evaluate the sustained clinical value of comprehensive noise reduction nursing.

CONCLUSION

Comprehensive noise reduction nursing was associated with alleviation of postoperative pain, improvement of sleep quality, reduction in incidence of T-tube-related complications, attenuation of stress response and enhancement of quality of life and readiness for hospital discharge in patients with T-tube drainage after choledocholithiasis surgery.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Author contributions

Dandan Cheng: conceptualization, methodology, project administration, supervision, writing − review & editing.

Hui Liu: data curation, investigation, writing − original draft.

Zhanchang Xie: formal analysis, software, validation.

Ziwen Liu: resources, visualization, writing − review & editing.

All authors have read and approved the final manuscript.

Ethics approval and consent to participate

This study was conducted in accordance with the Declaration of Helsinki and approved by the Medical Ethics Committee of Fuyang People’s Hospital (Ethics number: Medical Ethics Review [2026] No. 73). Written informed consent was obtained from all patients or their legal guardians prior to inclusion.

Acknowledgement

The authors thank the nursing staff of the Department of Hepatobiliary and Pancreatic Surgery at Fuyang People’s Hospital for their assistance in data collection and patient care.

Conflicts of interest

All authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Funding Statement

This study received no external funding.