Yu-Quan Tian,1,* Xiu-Fang Lv,1,* Min Zhang,2 Meng Gao,3 Lei Zhao1 

1Department of Operation Room, Shandong Provincial Third Hospital, Jinan, Shandong, 250031, People’s Republic of China; 2Department of General Surgery, Jinan Seventh People’s Hospital, Jinan, Shandong, 250132, People’s Republic of China; 3Department of Nursing, Jinan Seventh People’s Hospital, Jinan, 250132, Shandong, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Min Zhang, Department of General Surgery, Jinan Seventh People’s Hospital, Jinan, Shandong, 250132, People’s Republic of China, Tel +8618668987606, Email zhangmin3469@outlook.com

Objective: To investigate the impact of pathway-based care on patients with cholelithiasis undergoing daytime cholecystectomy.
Methods: Two hundred fifty-eight patients scheduled for daytime cholecystectomy were randomly assigned to a pathway care group and a control group (129 each). The control group received standard care, while the pathway care group received additional pathway-based care to assess its effectiveness.
Results: Before surgery (T0), there were no significant differences between the groups in stress response indicators, including body temperature (T), heart rate (HR), blood oxygen saturation (SpO2), and blood glucose levels (P > 0.05). Ten minutes after the onset of intraoperative pneumoperitoneum (T1), the pathway care group did not exhibit significant changes in T, HR, or blood glucose levels compared to pre-surgery values (P > 0.05), but SpO2 significantly improved (P < 0.05). In contrast, all stress response indicators in the control group worsened at T1 compared to baseline (P < 0.05). At the end of surgery (T2), the pathway care group maintained stable stress response indicators relative to baseline (P > 0.05), while the control group showed significant increases (P < 0.05). Additionally, hospitalization time in the pathway care group was significantly lower compared to the control group (P < 0.05). Comparisons of postoperative complication rates in the pathway care group revealed that the pathway care group had significantly lower incidences of abdominal pain, incisional infection, and venous thrombosis compared to the control group (P < 0.05). When comparing the postoperative quality of life (SF-36) scores, the pathway care group had higher quality of life scores than the control group (P < 0.05), as well as in scores across all dimensions (P < 0.05).
Conclusion: Pathway-based care for cholecystectomy patients enhances operating room nursing quality and efficiency. It minimizes intraoperative stress response, reduces complications, and improves patient quality of life.

Keywords: cholecystectomy, clinical care pathway, concept of enhanced recovery after surgery, daycare pathway, laparoscopic surgery, perioperative stress condition