Impact of narrative therapy and standard ostomy care on postoperative recovery and complications in permanent colostomy

Table 1 Baseline demographic and clinical characteristics, n (%)/mean ± SD

Indicators	SOC group (n = 76)	NTSOC group (n = 72)	t/χ2	P value
Age (years)	58.34 ± 7.29	59.10 ± 6.86	0.655	0.514
Gender (male/female)	42 (55.26)/34 (44.74)	38 (52.78)/34 (47.22)	0.092	0.762
Body mass index	23.16 ± 3.11	22.88 ± 3.44	0.522	0.603
Education level			0.617	0.734
Primary school or below	16 (21.05)	19 (26.39)
High school	35 (46.05)	30 (41.67)
University or above	25 (32.89)	23 (31.94)
Marital status			1.302	0.522
Single	21 (27.63)	16 (22.22)
Married	50 (65.79)	48 (66.67)
Divorced or widowed	5 (6.58)	8 (11.11)
Reason for surgery (colorectal cancer/other)	64 (84.21)/12 (15.79)	65 (90.28)/7 (9.72)	1.216	0.270
Preoperative hemoglobin (g/L)	118.45 ± 10.33	119.02 ± 9.87	0.343	0.732
Preoperative albumin (g/L)	36.78 ± 4.12	36.55 ± 4.01	0.335	0.738
Diabetes mellitus	11 (14.47)	9 (12.50)	0.123	0.726
Hypertension	29 (38.16)	28 (38.89)	0.008	0.927

SOC: Standard ostomy care; NTSOC: Narrative therapy combined with standard ostomy care.

Table 2 Intraoperative and stoma-related characteristics, n (%)/mean ± SD

Indicators	SOC group (n = 76)	NTSOC group (n = 72)	t/χ2	P value
Surgery duration (minutes)	165.46 ± 22.83	168.12 ± 25.45	0.669	0.504
Intraoperative blood loss (mL)	110.50 ± 20.35	115.25 ± 24.12	1.298	0.196
Stoma diameter (cm)	2.65 ± 0.42	2.69 ± 0.45	0.609	0.544
Surgical approach (laparoscopic surgery/open surgery)	48 (63.16)/28 (36.84)	45 (62.50)/27 (37.50)	0.007	0.934
Stoma location			0.100	0.951
Through rectus abdominis	71 (93.42)	68 (94.44)
Pararectus	4 (5.26)	3 (4.17)
Through umbilicus	1 (1.32)	1 (1.39)

SOC: Standard ostomy care; NTSOC: Narrative therapy combined with standard ostomy care.

Table 3 Postoperative gastrointestinal function recovery, mean ± SD

Indicators	SOC group (n = 76)	NTSOC group (n = 72)	t	P value
Time to first bowel sounds recovery	46.76 ± 9.06	42.28 ± 7.53	3.259	0.001
Time to first fluid intake (hours)	56.43 ± 8.26	48.24 ± 6.57	6.654	< 0.001
Time to first flatus passage (hours)	48.93 ± 10.29	43.95 ± 8.62	3.180	0.002
Time to first postoperative bowel movement (hours)	71.57 ± 12.61	65.83 ± 10.48	3.001	0.003

SOC: Standard ostomy care; NTSOC: Narrative therapy combined with standard ostomy care.

Table 4 Postoperative activity recovery and hospital stay, mean ± SD

Indicators	SOC group (n = 76)	NTSOC group (n = 72)	t	P value
Time to first sitting up (hours)	18.74 ± 4.57	16.97 ± 3.23	2.730	0.007
Time to first ambulation (hours)	25.31 ± 6.11	23.14 ± 4.56	2.459	0.015
Time to first independent walking postoperatively (days)	3.75 ± 1.14	3.31 ± 0.97	2.548	0.012
Length of hospital stay (days)	12.37 ± 2.31	11.46 ± 2.19	2.439	0.016

SOC: Standard ostomy care; NTSOC: Narrative therapy combined with standard ostomy care.

Table 5 Stoma-related complications within 3 months postoperatively, n (%)

Indicators	SOC group (n = 76)	NTSOC group (n = 72)	χ2	P value
Peristomal dermatitis	13 (17.11)	3 (4.17)	6.419	0.011
Fecal dermatitis	11 (14.47)	3 (4.17)	4.586	0.032
Parastomal hernia	3 (3.95)	1 (1.39)	0.205	0.651
Stoma stenosis/protrusion	2 (2.63)	0 (0.00)	0.454	0.501
Total incidence rate	29 (38.16)	7 (9.72)	16.241	< 0.001

SOC: Standard ostomy care; NTSOC: Narrative therapy combined with standard ostomy care.

Table 6 Social Impact Scale subscale scores immediately postoperatively and at 3 months postoperatively, mean ± SD

Indicators	SOC group (n = 76)	NTSOC group (n = 72)	t	P value
Immediate postoperative
Sense of social isolation	21.53 ± 4.16	21.78 ± 4.17	0.378	0.706
Economic insecurity	12.24 ± 2.64	12.52 ± 2.46	0.655	0.513
Internalized shame	15.36 ± 3.19	15.16 ± 3.25	0.379	0.705
Perceived social exclusion	24.81 ± 4.59	24.49 ± 4.41	0.433	0.666
3-month follow-up
Sense of social isolation	15.54 ± 4.29	14.21 ± 3.18	2.153	0.033
Economic insecurity	11.25 ± 2.61	10.55 ± 2.44	1.699	0.091
Internalized shame	11.34 ± 3.37	9.84 ± 2.83	2.922	0.004
Perceived social exclusion	19.53 ± 4.71	17.34 ± 4.26	2.962	0.004

SOC: Standard ostomy care; NTSOC: Narrative therapy combined with standard ostomy care.