Published online Sep 27, 2026. doi: 10.4240/wjgs.122413
Revised: May 18, 2026
Accepted: June 24, 2026
Published online: September 27, 2026
Processing time: 150 Days and 22.4 Hours
Acute gastrointestinal perforation is a life-threatening surgical emergency requiring rapid intervention. Although enhanced recovery after surgery (ERAS) is well known in elective procedures, its efficacy in emergency open repair remains poorly studied due to severe systemic inflammation and limited preoperative preparation time.
To evaluate the impact of evidence-based ERAS nursing on perioperative outcomes in patients undergoing open surgical repair for gastrointestinal perforation.
A retrospective study was conducted on 100 patients who underwent open surgical repair of gastrointestinal perforation at the First Affiliated Hospital of Soochow University from June 2023 to May 2025. Patients were divided into a control group (n = 50) that received standard nursing care and an observation group (n = 50) that received evidence-based ERAS nursing. The study compared intraoperative parameters, perioperative recovery metrics (time to first postoperative ambulation, first flatus, and first oral liquid intake; postoperative hospital stay; and Numerical Rating Scale pain score on postoperative day 3), as well as operative duration, intraoperative blood loss, and postoperative complications. Systemic inflammatory markers, including white blood cell (white blood cell count, C-reactive protein), and serum albumin, were measured before surgery and on days 1 and days 3 after surgery. Patient satisfaction with nursing care was also evaluated between groups.
Compared with the control group, patients in the observation group showed significantly improved postoperative recovery outcomes (all P < 0.05). Specifically, the observation group achieved earlier postoperative ambulation (12.36 ± 4.15 hours vs 26.85 ± 8.74 hours), earlier first flatus (42.18 ± 10.22 hours vs 65.43 ± 15.67 hours), and earlier initiation of oral liquid intake (20.54 ± 6.33 hours vs 48.72 ± 12.41 hours). Postoperative hospital stay was significantly shorter in the observation group (7.25 ± 1.86 days vs 10.83 ± 2.95 days, P < 0.001). The postoperative day 3 Numerical Rating Scale pain score was also significantly lower (2.45 ± 0.87 vs 4.62 ± 1.23, P < 0.001). In addition, the overall postoperative complication rate was significantly reduced in the observation group compared with the control group (12.0% vs 34.0%, P = 0.009). On postoperative day 3, white blood cell count and C-reactive protein levels decreased more markedly, whereas serum albumin recovery was significantly better in the observation group (all P < 0.05). Patient satisfaction scores were significantly higher in all evaluated domains in the observation group (all P < 0.05).
The study concluded that evidence-based ERAS nursing strategies substantially improve postoperative recovery, reduce hospitalization duration and the frequency of postoperative complications, and reduce postoperative inflammatory responses in patients undergoing open surgical repair for gastrointestinal perforation. The results showed significant clinical relevance and broad applicability of ERAS nursing in this patient population. These findings suggest important implications for future clinical practice and healthcare delivery.
Core Tip: The results of this study demonstrate the feasibility of implementing enhanced recovery after surgery (ERAS) nursing in emergency gastrointestinal perforation repair, with observable clinical impact. ERAS nursing effectively optimizes stress responses, facilitates early functional recovery, reduces postoperative complications, and improves patient-centered outcomes through integrated multidisciplinary perioperative management strategies. These results support wider implementation of ERAS principles in nursing practice for emergency abdominal surgery.