Effect of emergency integrated traditional Chinese and Western medicine plus clinical nursing pathway in surgically-treated acute appendicitis patients

Abstract

BACKGROUND

Given the high risk of postoperative complications in patients undergoing surgery for acute appendicitis (AA), optimizing management methods is critical.

AIM

To elucidate the effects of emergency integrated traditional Chinese and Western medicine (ITCWM) combined with clinical nursing pathway (CNP) on surgical candidates for AA.

METHODS

A retrospective analysis was conducted on 130 individuals with AA requiring surgical intervention at Tianjin Nankai Hospital from September 2022 to September 2025. This cohort included 60 cases in the control group, which received routine nursing care, and 70 patients in the research group, who were treated with emergency ITCWM and CNP. Comparative analyses between the groups assessed several factors, including surgical recovery (time to bowel sound recovery, first flatus, ambulation, and length of hospital stay), postoperative pain (measured by the Numeric Rating Scale), mental state (Hamilton Depression/Anxiety Scale), sleep quality (Pittsburgh Sleep Quality Index), and complications (ileus, uroschesis, incision infection).

RESULTS

The data revealed a significantly shorter time to bowel sound recovery, first flatus, and ambulation, along with earlier hospital discharge and lower Numeric Rating Scale scores on postoperative days 1 and 3 in the research group compared to controls. Reductions in Hamilton Depression Scale, Hamilton Anxiety Scale, and Pittsburgh Sleep Quality Index scores were noted on the 1^st and 3^rd postoperative days, alongside a lower total complication rate (7.14% vs 20.00%).

CONCLUSION

The integration of emergency ITCWM and CNP demonstrates substantial advantages for AA patients requiring surgery, indicating a strong potential for clinical application.

Key Words: Emergency; Integrated traditional Chinese and Western medicine; Clinical nursing pathway; Acute appendicitis surgery; Application effect

Core Tip: This study aims to evaluate the effectiveness of emergency integrated traditional Chinese and Western medicine combined with clinical nursing pathway compared to conventional nursing in patients undergoing surgery for acute appendicitis. A series of evaluations indicated that integrated traditional Chinese and Western medicine plus clinical nursing pathway offers significant clinical advantages for acute appendicitis surgery patients, evidenced by enhanced gastrointestinal function, accelerated recovery, improved pain relief, reduced negative emotions, and improved sleep quality, along with a preventive effect on complications.

INTRODUCTION

Acute appendicitis (AA), recognized as the most prevalent indication for emergency abdominal surgery globally, is a significant cause of hypogastralgia[1]. Annually, AA occurs in approximately 90 to 100 per 100000 individuals, with a lifetime risk of 12% and a notable predilection for males[2,3]. This condition, characterized by cecal-appendiceal inflammation, results from appendiceal lumen obstruction, which may be etiologically linked to factors such as fecalith formation, fecal blockage, lymphatic hyperplasia, or tumors[4]. Such obstruction can lead to edema, vascular congestion, ischemia, and the risk of appendiceal perforation, potentially resulting in abdominal abscess or systemic peritonitis[5]. Treatment options for AA include surgical intervention or antibiotic therapy. Surgical treatment aims to remove the appendix, while antibiotic therapy achieves circumvention of surgery in approximately 67% of cases through sterilization[6]. Nonetheless, antibiotic therapy has been associated with a higher failure rate in surgical treatment[7]. Patients with AA face a substantial risk of developing postoperative complications (POCs). Techniques such as external application of Xiaoyan San, acupoint application, and oral administration of Dahuang Mudan Decoction have shown significant therapeutic effects in AA management[8]. Rheum officinale (Dahuang), a key ingredient in Furong San, promotes diuresis, alleviates jaundice, purges heat, relaxes the bowels, and detoxifies to eliminate carbuncles. Other components, including Scutellaria baicalensis Georgi, Coptidis Rhizoma, and Cortex Phellodendri, are effective in clearing heat and dampness, purging fire, and detoxifying; while Folium Hibisci Mutabilis and Herba Lycopi reduce swelling, alleviate pain, and promote circulation. Borneol contributes heat-clearing and detoxifying effects. The external application of these compounds to the right lower abdomen provides synergistic effects of detumescence, pain relief, heat clearance, and detoxification[9]. Acupoint application, utilizing medicinal patches (e.g., Allium macrostemon and Rheum officinale) at specific acupoints (e.g., Zusanli, Tianshu) prior to surgery, regulates spleen and stomach function, dredges channels and collaterals, enhances qi flow, and alleviates pain[10]. Preoperative administration of Dahuang Mudan Decoction helps to clear heat, dispel blood stasis, expel pus, and eliminate carbuncles. Postoperatively, the application of hot compress packs to the Shenque acupoint, combined with oral administration of Houpu Sanwu Decoction and moxibustion at the Zhongwan acupoint, promotes qi-blood circulation, warms the middle energizer, and addresses deficiencies[11]. To further mitigate the risk of POC in AA patients, effective nursing models are essential for complication prevention[12]. Compared to conventional nursing, the clinical nursing pathway (CNP) offers a more structured nursing approach, optimizing the perioperative medical experience and maximizing therapeutic efficacy for AA patients[13].

Currently, the effectiveness of emergency integrated traditional Chinese and Western medicine (ITCWM) combined with CNP in surgical candidates for AA remains largely unexplored. This study aims to conduct a comparative evaluation (CNP + emergency ITCWM vs routine nursing) to enhance clinical management options for patients undergoing surgical treatment for AA.

MATERIALS AND METHODS

Patient data

Inclusion in this study necessitated a definitive diagnosis of AA confirmed via abdominal color Doppler ultrasonography and computed tomography[14]. Eligible participants were required to meet the criteria for laparoscopic appendectomy, be treatment-naive, receive surgery at our hospital by the same physician group, fall within the age range of 20 to 70, possess normal communication and cognitive abilities, and have complete medical records. Exclusion criteria included the presence of other acute abdominal conditions (e.g., ureteral calculi), diabetes, immune dysfunction, coagulation disorders, prior AA or related treatments, intolerance to medications used in emergency ITCWM therapy, preoperative appendiceal perforation or peripheral abscess leading to systemic infection, malignancies, hematologic disorders, abnormal vital organ function, or being pregnant or lactating.

Following approval from the Institutional Ethics Committee and a rigorous screening process based on these criteria, 130 individuals diagnosed with AA and surgically treated at Tianjin Nankai Hospital (from September 2022 to September 2025) were retrospectively included. This cohort comprised 60 control patients who received routine nursing care and 70 patients in the research group who underwent CNP plus emergency ITCWM therapy. No significant inter-group differences were observed regarding general patient demographics (P > 0.05).

Nursing methods

Both groups underwent laparoscopic appendectomy. Postoperatively, treatment regimens included antibiotics, gastric protection, fluid replacement, and symptomatic therapies as per medical standards. The control group received routine nursing, which involved preoperative fasting, water deprivation, health education, postoperative dietary advice, complication prevention, and discharge instructions.

Patients in the research group additionally received emergency ITCWM intervention combined with CNP. Prior to the traditional Chinese medicine (TCM) intervention, Furong San was prepared externally as a paste with yellow rice wine, wrapped in medical-grade tissue paper and gauze, applied to the right lower abdomen, and secured with adhesive tape. Subsequently, acupoint application was performed using a mixture of Bulbus Allii Macrostemonis, Rhizoma Cyperi, Cortex Magnolia Officinalis, Fructus Aurantii, Flos Caryophylli, Rhizoma Zingiberis, Cortex Cinnamomi, Scorpio, Rheum officinale, and Natrii Sulfas, combined with sesame oil or Vaseline, and applied to the inner side of acupoint patches for application to Zusanli, Neiguan, Zhongwan, Pishu, and Weishu acupoints. For postoperative intervention, in cases where anal exhaust or bowel movement did not occur within 12 hours post-operation, TCM acupoint application was employed at Zusanli, Neiguan, and Zhongwan acupoints. Additionally, direct moxibustion was performed at Zusanli and Neiguan, along with suspended moxibustion at Dachangshu, Zhongwan, Liangmen, and Guanyuan acupoints. In addition, the CNP was implemented during the perioperative period, encompassing the following components: (1) Preoperative health education: Patients received education regarding the common types, symptoms, etiology, pathogenesis, and treatment of AA. This comprehensive approach facilitated their understanding of the condition, allowed for psychological preparation for surgery, and enhanced their mastery of disease-related knowledge, ultimately boosting confidence in surgical outcomes; (2) Preoperative psychological counseling: Nursing staff engaged actively with patients to grasp their inner thoughts, utilizing communication strategies tailored to the patients’ educational backgrounds. This approach ensured effective communication, particularly through the use of accessible language for less-educated individuals. By thoroughly understanding the origins of patients’ negative emotions, targeted counseling was provided. When necessary, communication with family members was fostered, guiding them to assist nursing staff in completing the psychological counseling process; (3) Preoperative surgical preparation: All preoperative examinations, including electrocardiograms, blood tests, and blood type assessments, were thoroughly completed. Blood products required for the procedure were prepared in advance. Patients were instructed to abstain from food and water before the operation, with venous access established as directed. Skin preparation was performed 30 minutes prior to surgery, ensuring that all medications, instruments, and devices needed for the operation were organized beforehand; (4) Intraoperative cooperation: The nursing staff worked closely with the surgeon to facilitate the operation, ensuring the precise and prompt delivery of various instruments to reduce surgical duration while assisting with all necessary auxiliary tasks; (5) Intraoperative temperature care: A comfortable operating room environment was maintained, with temperature set between 24-26 °C and humidity at 50%-60%. Additionally, blankets were used to keep the patient warm, and the infusing liquid was pre-warmed prior to the operation; (6) Intraoperative vital sign monitoring: Continuous monitoring of the patient’s blood pressure, respiration, heart rate, arterial oxygen saturation, body temperature, and other vital signs was conducted. Immediate notification to the physician occurred upon detection of any abnormalities to ensure the surgical process remained smooth. Additionally, timely cleaning of the patient’s respiratory secretions was performed to prevent obstruction; (7) Postoperative dietary intervention: A temporary fasting period was enacted post-surgery, during which only small amounts of liquid diets (e.g., rice soup, egg flower soup) were permitted following the passage of gas. Gradual transition to a semi-liquid diet occurred as gastrointestinal function recovered. After discharge, patients were allowed to resume a normal diet, adhering to guidelines of light meals, avoidance of irritating foods, and small, frequent portions. Early ambulation was encouraged following physical rehabilitation to promote gastrointestinal motility; (8) POC prevention and care: Incision care involved regular dressing changes. In cases of wound pain, swelling, or fever, timely anti-inflammatory treatment with medications such as iodophor was administered to prevent infection. Respiratory care addressed sticky secretions that could not be expelled through back percussion by employing nebulizer inhalation, thereby reducing the risk of suffocation. After the removal of the urethral catheter, close observation of the patient’s urination and wound healing was maintained. Daily abdominal massage with appropriate intensity was performed to prevent constipation. To enhance blood circulation, the patient’s lower limbs were appropriately elevated, with family members guided to perform distal-to-proximal massages; (9) Postoperative pain care: Strategies were implemented to help post-surgical patients divert their attention from pain, including conversation and music. Severe pain was managed with analgesics as directed by medical advice; and (10) Early activity guidance: Nursing staff emphasized the significance of early postoperative activities to patients and their families, guiding and assisting them with early ambulation. Instruction on functional training, such as postoperative gas-expelling exercises, was also provided.

Outcome measures

Surgical recovery: The parameters assessed included the time to bowel sound recovery, first flatus, ambulation, and the length of hospital stay to evaluate postoperative recovery. Bowel sound recovery time was defined as the duration until clear bowel sounds were first detected during postoperative auscultation (auscultation duration ≥ 3 minutes). The first exhaust time referred to the moment when the patient first subjectively perceived anal gas release after surgery. Ambulation time was measured as the period required for the patient to achieve out-of-bed standing or walking for the first time postoperatively. The length of hospital stay was recorded as the total number of days from the completion of surgery to the fulfillment of discharge criteria.

Postoperative pain: Patient pain levels were assessed on postoperative days 1 and 3 using the Numeric Rating Scale (NRS)[15], where 0 indicated no pain, 1-3 represented mild pain with minimal impact, 4-6 signified pain requiring intervention, and 7-10 indicated unbearable pain.

Mental state: Anxiety and depression were evaluated using the Hamilton Depression Scale (HAMD, 17 items totaling 0-52 points) and the Hamilton Anxiety Scale (HAMA, 14 items totaling 0-56 points)[16]. Higher scores on either scale reflected more severe adverse mood states.

Sleep quality: Sleep quality was assessed through domains including sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disorders, hypnotic drug use, and daytime dysfunction (0-3 points/dimension, totaling 21 points), utilizing the Pittsburgh Sleep Quality Index (PSQI)[17]. A total PSQI score of 5 points or above indicated the presence of sleep disorders, with scores inversely correlated with sleep quality.

Incidence of POCs: The occurrences of POCs such as ileus, uroschesis, and incision infection were monitored and recorded.

Statistical analysis

Normality testing of all measurement data was conducted using the Shapiro-Wilk test. For data exhibiting a Gaussian distribution, mean ± SD was employed for statistical description, with t-tests facilitating comparisons between groups and paired t-tests for within-group pre- and post-intervention comparisons. Non-Gaussian distributed data were expressed as median (interquartile range), utilizing the Mann-Whitney U test for inter-group evaluations and the Wilcoxon signed-rank test for intra-group comparisons. Categorical variables were represented using n (%), with differences examined via χ² tests. Data analysis was conducted using SPSS 22.0, with a significance level set at 0.05 for all statistical tests.

RESULTS

Patient baseline information

Table 1 presents the baseline data of the patients, confirming clinical comparability between the control and research groups (P > 0.05). Distributions in sex were balanced (male: 53.33% vs 51.43%; female: 46.67% vs 48.57%). Age was comparable (46.08 ± 6.73 years vs 46.97 ± 6.57 years), as was onset-to-operation time (17.53 ± 4.09 hours vs 16.99 ± 4.16 hours) and body mass index (22.70 ± 2.46 kg/m² vs 23.09 ± 2.38 kg/m²). Pathological types were also similar, with suppurative cases at 50.00% vs 51.43%, uncomplicated at 40.00% vs 34.29%, and gangrenous/perforated at 10.00% vs 14.29% (P > 0.05).

Table 1 Baseline patient data, n (%)/mean ± SD.

Indicators	Control group (n = 60)	Research group (n = 70)	χ2/t	P value
Sex			0.047	0.828
Male	32 (53.33)	36 (51.43)
Female	28 (46.67)	34 (48.57)
Age (years)	46.08 ± 6.73	46.97 ± 6.57	0.761	0.448
Onset-to-operation time (hours)	17.53 ± 4.09	16.99 ± 4.16	0.867	0.387
Body mass index (kg/m2)	22.70 ± 2.46	23.09 ± 2.38	0.917	0.361
Pathological type			0.781	0.677
Suppurative	30 (50.00)	36 (51.43)
Uncomplicated	24 (40.00)	24 (34.29)
Gangrenous/perforated appendicitis	6 (10.00)	10 (14.29)

Surgical recovery across groups

Figure 1 visually displays the recovery status of post-surgical patients, indicating significantly shorter times to bowel sound recovery (13.73 ± 4.07 hours vs 19.82 ± 4.59 hours), first flatus (22.61 ± 3.53 hours vs 27.38 ± 4.78 hours), and ambulation [3.00 (2.00, 4.00) days vs 4.00 (3.00, 5.00) days] in the research group, along with reduced lengths of hospital stays (5.07 ± 2.09 days vs 7.70 ± 2.59 days) compared to the control group (P < 0.001).

Figure 1 Inter-group comparison of the time to bowel sound recovery, first flatus, ambulation, and length of hospital stay. A: Time to bowel sound recovery across groups; B: Comparison of the time to first flatus; C: Time to ambulation assessment; D: Length of hospital stay across groups. ^cP < 0.001 in the between-group comparison.

Postoperative pain evaluation

Postoperative pain assessment utilizing the NRS is illustrated in Table 2. No significant differences in preoperative NRS scores were found [6.00 (4.00, 7.00) points vs 6.00 (4.25, 7.00) points; P > 0.05]. However, the research group demonstrated significantly lower NRS scores on postoperative days 1 [3.50 (2.00, 5.00) points vs 4.00 (3.00, 5.75) points] and 3 [2.00 (2.00, 3.00) points vs 4.00 (3.00, 5.00) points] compared to controls (P < 0.05).

Table 2 Between-group comparison of Numeric Rating Scale scores, median (interquartile range).

Indicators	Control group (n = 60)	Research group (n = 70)	Z	P value
Pre-operation	6.00 (4.25, 7.00)	6.00 (4.00, 7.00)	-0.637	0.524
1-day post-operation	4. 00(3.00, 5.75)	3.50 (2.00, 5.00)	-2.146	0.032
3-day post-operation	4.00 (3.00, 5.00)	2.00 (2.00, 3.00)	-5.013	< 0.001

Mental state analysis

Psychological state assessments, as depicted in Figure 2, showed comparable pre-treatment HAMD (30.50 ± 6.21 points vs 29.68 ± 4.77 points) and HAMA scores (27.51 ± 5.88 points vs 27.70 ± 4.73 points; P > 0.05). Notably, both scale scores significantly decreased in both cohorts post-intervention (P < 0.001), with lower scores observed in the research group compared to controls (HAMD: 10.00 ± 3.64 points vs 15.33 ± 5.25 points; HAMA: 9.13 ± 2.96 points vs 12.63 ± 3.63 points; P < 0.05).

Figure 2 Comparative Hamilton Depression Scale and Hamilton Anxiety Scale score assessments. A: Pre- and post-interventional Hamilton Depression Scale scores; B: Pre- and post-interventional Hamilton Anxiety Scale scores. ^aP < 0.05, ^bP < 0.01, ^cP < 0.001. HAMD: Hamilton Depression Scale; HAMA: Hamilton Anxiety Scale.

Sleep quality comparison

The quantification of sleep quality based on the PSQI, shown in Table 3, indicated equivalent preoperative PSQI scores across groups (13.41 ± 2.22 points vs 13.97 ± 2.93 points; P > 0.05). However, greater reductions in PSQI scores were noted in the research group on postoperative days 1 and 3 (postoperative day 1: 8.91 ± 2.18 points vs 10.62 ± 2.34 points; day 3: 6.44 ± 1.75 points vs 8.20 ± 1.91 points; P < 0.001).

Table 3 Comparison of perioperative Pittsburgh Sleep Quality Index scores, mean ± SD.

Indicators	Control group (n = 60)	Research group (n = 70)	t	P value
Pre-operation	13.97 ± 2.93	13.41 ± 2.22	1.238	0.218
1-day post-operation	10.62 ± 2.34	8.91 ± 2.18	4.310	< 0.001
3-day post-operation	8.20 ± 1.91	6.44 ± 1.75	5.480	< 0.001

POC analysis

Table 4 summarizes the occurrences of POCs, including ileus, uroschesis, and incision infection, in both cohorts. The comparison revealed that 5 cases in the research group and 12 in the control group developed these complications, with the overall incidence difference reaching statistical significance (7.14% vs 20.00%; P = 0.030).

Table 4 Comparison of postoperative complications, n (%).

Indicators	Control group (n = 60)	Research group (n = 70)	χ2	P value
Ileus	3 (5.00)	2 (2.86)
Uroschesis	5 (8.33)	1 (1.43)
Incision infection	4 (6.67)	2 (2.86)
Total complications	12 (20.00)	5 (7.14)	4.698	0.030

DISCUSSION

This report first established that the integration of emergency ITCWM and CNP significantly enhances surgical recovery in AA patients undergoing surgery, markedly reducing the time required for bowel sound recovery, first flatus, ambulation, and hospital stays. This improvement may be attributed to the detailed, standardized, and meticulous nursing services delivered through the emergency ITCWM + CNP intervention. These services encompass comprehensive measures across the perioperative spectrum, including preoperative interventions (TCM nursing interventions, health education, psychological counseling, surgical preparation), intraoperative care (cooperation, body temperature management, vital sign monitoring), and postoperative measures (dietary intervention, complication prevention and care, pain management), thereby facilitating a holistic acceleration of postoperative recovery[18]. Additionally, the concurrent use of external Furong San application and acupoint therapy (at sites such as Zusanli and Tianshu) further achieved purgative effects to unblock the interior and harmonize spleen and stomach, thus promoting early gastrointestinal function recovery, ambulation, and shortening hospital discharge times[19,20]. Supporting these findings, Yang[21] reported similar reductions in time to intestinal sound recovery, anal exhaust, anal defecation, and hospital discharge for appendicitis patients under CNP care.

Moreover, the combination of emergency ITCWM and CNP for AA-affected surgical candidates was shown to mitigate pain on the first and third postoperative days. This analgesic effect may be linked to the local anti-inflammatory and decongestive properties of Furong San, alongside the significant pain relief from perioperative acupoint application at Zusanli and Neiguan[22,23]. CNP further contributes by offering POC prevention and pain management, which effectively alleviates postoperative pain through POC reduction, attention distraction, and timely analgesic interventions. Hong et al[24] reported that CNP for AA-affected children requiring surgery could significantly reduce abnormal postoperative increases in cortisol and norepinephrine, while also diminishing pain intensities at 6, 12, and 24 hours post-operation, thereby corroborating our findings.

Using HAMD and HAMA to assess mental states, the findings indicate that the emergency ITCWM + CNP intervention surpassed conventional nursing in alleviating anxiety and depression among AA patients requiring surgical treatment. This efficacy can be attributed to two main factors: (1) The effective pain relief provided by emergency ITCWM; and (2) The ability of perioperative acupoint application at Zusanli to modulate depression through inhibition of the Toll-like receptor 4/p38 mitogen-activated protein kinase/nuclear factor κB/NOD-like receptor protein 3 pathway[25]. Further support for these results arises from various effective interventions implemented within the CNP model. Preoperative health education assisted patients in developing a correct understanding of their condition, thereby alleviating fears associated with the illness and unknown surgical procedures. Additionally, preoperative psychological counseling - characterized by active communication and targeted support - helped reduce psychological pressure, diminish nervousness, and enhance patients’ confidence and compliance with surgical treatment. Yin and Wu[26] reported similar findings, noting significant alleviation of anxiety in CNP-intervened AA patients at 48 hours post-operation, aligning with our observations. Moreover, research has indicated that electroacupuncture intervention at Neiguan can upregulate neuronal matrix metalloproteinase-9 expression via the brain-derived neurotrophic factor-tropomyosin receptor kinase B signaling pathway, facilitating the erasure of remote fear memories. This mechanism may partially elucidate how acupoint application at Neiguan aids in emotional regulation among the study patients[27]. Evaluation of sleep quality using the PSQI demonstrated significant enhancement in sleep quality among surgically treated AA patients under the emergency ITCWM + CNP protocol. Specifically, the Guanyuan acupoint is noted for its capacity to nourish vitality, warm the kidneys, and support yang[28]. The Zhongwan acupoint contributes to regulating spleen and stomach functions, modulating autonomic nerve balance, and reducing sympathetic nerve excitability during the early postoperative period, thus indirectly improving sleep quality[29]. The practice of suspended moxibustion at both Guanyuan and Zhongwan serves to replenish vital energy, warm the kidneys, and activate yang, thereby assisting in enhancing patients’ sleep quality. The CNP intervention substantially mitigates postoperative pain and adverse mood, facilitating effective POC prevention and promoting rapid recovery, which not only enhances patients’ perception of rehabilitation effects but also aids in relaxation and improvement of sleep quality. Chen et al[30] explored the impact of CNP on laparoscopic appendectomy patients, observing both accelerated postoperative recovery and substantial improvements in sleep quality, paralleling the results of this study.

A clinical safety evaluation conducted in this study revealed a significantly reduced incidence of overall POCs (ileus, uroschesis, and incision infection) among surgically managed AA patients receiving the emergency ITCWM + CNP intervention. Acupoint applications at Zusanli, Neiguan, and Zhongwan play a critical role in regulating gastrointestinal function, effectively preventing intestinal obstruction. For the suspended moxibustion intervention, Guanyuan, Zhongwan, and Dachangshu were selected, where Guanyuan is known to warm and tonify kidney yang, regulate the lower energizer, and prevent uroschesis. Meanwhile, Zhongwan and Dachangshu assist in modulating gastrointestinal function as well as promoting anal exhaust and defecation, which helps to lower the risk of ileus. The external application of Furong San has proven effective in preventing incision infections by inhibiting local inflammation. Furthermore, CNP facilitated intraoperative vital sign monitoring, ensuring the smooth progression of surgery and preventing respiratory tract obstruction. Comprehensive POC prevention and nursing care effectively reduced the POC rate by addressing the needs of the incision, respiratory tract, urinary system, abdomen, and lower limbs. In a randomized controlled trial, Jin et al[31] similarly demonstrated the high efficacy of CNP in reducing overall complications, such as abdominal infection, bleeding, puncture site infection, and subcutaneous emphysema, in patients with acute abdominal pain, with AA accounting for 85%.

Despite the positive findings, several limitations of this study warrant further consideration. First, the holistic nature of the emergency ITCWM + CNP therapy, characterized by the synergistic effects of multiple care measures, complicates the ability to isolate the independent contributions of each measure. Future research employing a factorial design could clarify the specific roles of individual measures. Second, the absence of evaluations on patient satisfaction, medical expenses, or cost-effectiveness necessitates prospective inclusion in follow-up studies to comprehensively assess the practical applicability of this nursing model in clinical contexts. Third, the lack of measurement of relevant biological markers means that the mechanisms discussed (e.g., inflammatory pathways, neurobiological mechanisms) remain speculative and are intended mainly to aid in interpreting clinical phenomena. Subsequent basic research is needed to explore these underlying mechanisms in greater depth. Additionally, the inherent limitations of the retrospective research design pose challenges; the inability to ensure comparability between groups concerning nursing compliance or unmeasured baseline characteristics (socio-economic status, educational background, family support, etc.) necessitates prospectively addressing these factors in future studies to minimize mixed bias and enhance inter-group comparability.

CONCLUSION

In conclusion, the emergency ITCWM + CNP therapy presents clear advantages over routine nursing for surgically managed AA patients. It facilitates gastrointestinal function recovery, shortens rehabilitation time, alleviates pain and adverse mood, enhances sleep quality, and reduces overall complication rates. This evidence supports the model’s potential as a superior management approach for AA patients undergoing surgery.