Continuous Nursing And Surgical Site Wound Infections In Colorectal Oncology
Overview
In a systematic evaluation, the impact of continuous nursing on surgical site wound infections and postoperative complications in colorectal cancer (CRC) patients with stomas was thoroughly examined. Through comprehensive searches of multiple databases, including Embase, PubMed, Cochrane Library, China National Knowledge Infrastructure, and Wanfang, clinical studies on CRC patients undergoing continuous nursing interventions post-colorectal stoma surgery were collected up to August 2023. Following independent screening, data extraction, and literature quality assessment by two researchers, a meta-analysis comprising 20 studies with 1759 patients was conducted using Stata 17.0.
The meta-analysis results revealed a significant reduction in the rates of surgical site wound infection (risk ratio [RR] = 0.24, 95% confidence interval [CI]: 0.14–0.43, p < 0.001) and postoperative complications (RR = 0.30, 95% CI: 0.23–0.39, p < 0.001) among CRC stoma patients who received continuous nursing interventions compared to the control group. Consequently, the findings strongly support the promotion of continuous nursing intervention in clinical care for CRC patients with stomas, highlighting its potential to enhance patient outcomes and reduce complications following colorectal stoma surgery.
Introduction
The prevalence of colorectal cancer (CRC) has risen globally, making it a significant cause of cancer-related deaths. Surgery, often involving ostomy creation, remains a primary treatment for CRC. However, ostomy surgery can profoundly impact patients’ physical, mental, and social well-being, necessitating effective postoperative nursing care to enhance their quality of life.
While conventional nursing addresses disease-related needs, it may fall short in addressing patients’ psychological issues and delivering high-quality care. Continuous nursing, involving ongoing professional support after discharge, has emerged as a promising approach to meet patients’ evolving needs and prevent postoperative complications.
This study aims to evaluate the impact of continuous nursing interventions on surgical site wound infections and postoperative complications in CRC patients with stomas. By providing evidence-based insights, the research seeks to enhance the effectiveness of colostomy care, thereby improving patient outcomes and quality of life.
Method
A comprehensive search of randomized controlled trials (RCTs) focused on continuous nursing for colorectal cancer (CRC) stoma patients was conducted across multiple databases, including Embase, PubMed, Cochrane Library, China National Knowledge Infrastructure, and Wanfang, covering literature up to August 2023 in any language. The search strategy employed a combination of subject terms and free words, including “continuous nursing,” “colorectal cancer,” and “enterostomy.” Additionally, relevant article reference lists were scrutinized, and investigators were contacted if necessary to ensure the inclusion of pertinent literature.
The inclusion criteria comprised patients with CRC stoma as participants, with the intervention involving continuous nursing for the experimental group while the control group received standard care. Outcome indicators included surgical site wound infection and postoperative complications, and only RCTs were considered for inclusion. Exclusion criteria encompassed studies not meeting intervention criteria, incomplete data or unavailable full texts, literature types like reviews or case reports, and sample sizes below 10.
Data extraction and quality assessment were conducted by two independent researchers who reviewed the title, abstract, and full text of retrieved documents against the inclusion criteria. Disputes were resolved through discussion between the researchers, with involvement from a third researcher if necessary. Extracted data included details like the first author, publication year, sample size, age, and sex. Furthermore, the quality of RCTs was evaluated using the Cochrane Risk of Bias Assessment Tool to ensure the reliability and validity of the included studies.
Statistical Analysis
The analysis in this study utilized Stata software version 17.0 to conduct all statistical analyses. The outcome indicator focused on counting data, with results presented as risk ratios (RR) along with corresponding 95% confidence intervals (95% CI). To evaluate heterogeneity among the included studies, both the I2 test and χ2 test were employed. A fixed-effects model was adopted when I2 was less than 50% and p-value exceeded 0.1, indicating minimal heterogeneity. Conversely, a random-effects model was applied when significant heterogeneity was detected, defined by I2 exceeding 50% and a p-value below 0.1.
To ensure the robustness and reliability of the findings, sensitivity analyses were performed using a one-by-one exclusion method. This approach helped assess the consistency of results when each study was excluded individually. Additionally, potential publication bias was examined through funnel plots and Begg’s tests, particularly when the number of included papers reached 10 or more. Statistical significance was set at a p-value less than 0.05, indicating a threshold for meaningful results. Overall, these methodological approaches aimed to ensure rigorous analysis and interpretation of the study outcomes.
Result
The systematic literature review conducted in this study aimed to investigate the effects of continuous nursing on surgical site wound infections and postoperative complications among colorectal cancer (CRC) stoma patients. The rigorous screening process involved retrieving 467 documents, from which 20 studies met the inclusion criteria, collectively representing 1759 patients. These studies, published between 2015 and 2023, underwent quality assessment to ensure the reliability of their findings.
The analysis of surgical site wound infections across the 20 studies revealed a notable outcome: the experimental group, receiving continuous nursing intervention, exhibited a significantly lower infection rate compared to the control group (1.59% vs. 6.62%). This finding suggests that the implementation of continuous nursing care may serve as a protective factor against wound infections in CRC stoma patients. Furthermore, sensitivity analysis, which involved excluding individual studies one by one, confirmed the stability of the results. Additionally, publication bias analysis, conducted through funnel plots, indicated no significant bias, thereby reinforcing the credibility of the findings.
In the evaluation of postoperative complications, the analysis similarly demonstrated a significant benefit associated with continuous nursing intervention. The experimental group exhibited a substantially lower complication rate compared to the control group (7.02% vs. 23.74%). This finding underscores the potential of continuous nursing care to mitigate postoperative complications in CRC stoma patients. Sensitivity analysis corroborated the robustness of these findings, indicating consistency across different study subsets. However, it’s noteworthy that publication bias analysis detected significant bias, emphasizing the need for cautious interpretation of these results and highlighting a potential area for future research to address.
Overall, the study provides compelling evidence suggesting that continuous nursing care holds promise in reducing both surgical site wound infections and postoperative complications among CRC stoma patients. These findings have significant implications for clinical practice, emphasizing the importance of implementing continuous nursing interventions to enhance patient outcomes in this population. Nonetheless, further research efforts are warranted to address potential biases and strengthen the evidence base, ultimately facilitating more conclusive insights and informing evidence-based clinical guidelines and practices.
Conclusion
Colorectal cancer (CRC) ranks as the third most prevalent malignant tumor globally, with a significant burden on public health. While the incidence of CRC has decreased in developed nations, it has risen notably in countries like China. Enterostomy, a common surgical treatment for CRC, aims to control cancer metastasis and extend patient survival. However, it often leads to physiological and psychological complications, with up to 67.26% occurring within a year post-surgery. Physiological complications include peristomal skin inflammation, skin-mucosal separation, and parastomal hernia, while psychological challenges involve anxiety, depression, and a sense of stigma.
Despite its life-saving potential, enterostomy surgery often results in low patient satisfaction due to complications, family burden, and self-image issues. Targeted nursing interventions are crucial to enhancing patient understanding, alleviating negative emotions, and reducing complications, thereby improving their quality of life. Continuous nursing, extending care from hospital to home settings, has emerged as an effective intervention model. Studies indicate that continuous nursing significantly lowers wound infection and complication rates compared to conventional nursing.
In conclusion, continuous nursing interventions for CRC stoma patients have demonstrated effectiveness in reducing wound infections and complications while enhancing overall quality of life. The study underscores the importance of further research and clinical promotion of continuous nursing interventions to optimize patient outcomes. While the current study’s sample size is limited, future large-scale multicenter studies are warranted to validate these findings and provide robust evidence for clinical practice.
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