Effects of Nursing Care Using a Fast-Track Surgery Approach in 49 Patients with Early-Stage Hepatocellular Carcinoma Undergoing First-Line Treatment with Radiofrequency Ablation: A Retrospective Study

Background

Since the Danish surgeon Kehlet proposed the concept of fast-track surgery (FTS) in 2001, it has been gradually developed around the world, combined with the multidisciplinary progress in anesthesiology, minimally invasive surgery, and nursing technology in recent years [1]. The basic tenet of FTS is to treat the patient’s disease by minimal disturbance of their physiology. The protocol encompasses preoperative, intraoperative, and postoperative interventions, which when carried out together show maximal benefits [2].

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors treated in clinical practice. In recent years, the incidence rate has been increasing yearly, ranking sixth in the global tumor incidence rate and the fourth in the global tumor mortality rate [3], which seriously threatens people’s lives and health.

Radiofrequency ablation (RFA) is a safe, minimally invasive, and efficient new surgical method. It uses electric current to make ions in cancer tissue oscillate at high speed and generate local high temperature to cause coagulation necrosis of cancer tissue. RFA is accepted as the best therapeutic choice for patients with early-stage hepatocellular carcinoma when liver transplantation or surgical resection are not suitable options according to the Cardiovascular and Interventional Radiological Society of Europe [4], nd it has been widely used in patients with liver cancer [5]. Many previous studies have shown the advantages of rapid rehabilitation surgery in hepatobiliary surgery [6,7]. However, its application in radiofrequency ablation is rarely reported. Therefore, this retrospective study aimed to evaluate the effects of nursing care using an FTS approach in 49 patients with early-stage hepatocellular carcinoma (HCC) undergoing first-line treatment with radiofrequency ablation (RFA).

Material and Methods

GENERAL INFORMATION:

There were 49 HCC patients diagnosed as hepatocellular carcinoma by pathological or imaging examination, which was in line with surgical indications of ablative therapy. Of these, 24 patients were in the 2020 group, including 19 males and 5 females, aged 52–80 years, with an average of (64.4±9.3) years. Liver function Child grading: Grade A 18 cases, grade B 6 cases. In the 2021 group, 25 patients were enrolled, including 20 males and 5 females, aged 47–87 years, with an average age of (63.8±10.1) years. Liver function Child grading: 19 cases of grade A, 6 cases of grade B. There were no significant differences in age, sex, liver function Child grade, or other general data between the 2 groups (P>0.05), indicating comparability. This study was approved by the Research Ethics Committee of the Affiliated Hospital of Jiaxing University. All the patients in this study provided written informed consent.

MEASURES:

The concept of fast tract surgery was introduced in our hospital January 2021, and the department has taken care of patients in accordance with the requirements of rapid rehabilitation surgery. Since FTS has been widely shown to benefit patients in many other departments, we regard this model of care positively [8,9].

Patients in the 2021 group received more health education and psychological care, and the nurses told the patients all about the FTS process and encouraged them to do preoperative pulmonary function exercises and early postoperative activities. These patients had shorter preoperative fasting and faster postoperative resumption of eating. During the operation, a warm blanket was used to keep patients warm, fluid infusion was limited, attention was paid to oxygen inhalation and oxygen saturation maintenance, blood pressure was maintained, and liver perfusion was ensured. Patients could quickly determine the analgesic effect, and the reasons for poor analgesic effect were examined and dealt with. The indications to use antibiotics were stricter. Furthermore, improved postoperative monitoring and discharge evaluation were applied. More details of differences in nursing care between the 2 groups are shown in Table 1.

STATISTICAL ANALYSIS:

For data analyzed with a two-sample t test, the data are presented as mean±standard error. Pearson’s χ² test or Fisher’s exact test was used to compare qualitative variables. Statistical analyses were performed using SPSS 21.0. Test level α=0.05, P<0.05 indicated a statistically significant difference.

Results

COMPARISON OF POSTOPERATIVE RECOVERY CONDITIONS:

The postoperative time to first flatus, infusion time, hospitalization time, and total cost the 2021 group were significantly better than those in the 2020 group, and the difference between the groups was statistically significant, as shown in Table 2. The postoperative time to first flatus (15.84±7.05 vs 24.08±7.66 h, P<0.05), the infusion time (1.88±1.01 vs 2.79±1.53 days, P<0.05), and the hospitalization time (2.24±0.93 vs 3.17±1.93 days, P<0.05) were shorter in the 2021 group and the cost was lower (21700±4509 vs 25754±7076 yuan, P<0.05).

COMPARISON OF POSTOPERATIVE PAIN:

The pain scores of patients at 6 h (2.04±0.68 vs 2.63±0.71, P<0.05), 12 h (1.92±0.49 vs 2.38±0.49, P<0.05) and 24 h (1.84±0.37 vs 2.08±0.29, P<0.05) after surgery in the 2021 group were lower than those in the 2020 group, and the difference between the groups was statistically significant, as shown in Table 3.

COMPARISON OF POSTOPERATIVE COMPLICATIONS:

The incidence of postoperative complications in the 2021 group was lower than that in the 2020 group, and the difference between the groups was statistically significant (χ2=11.54, P<0.05), as shown in Table 4.

COMPARISON OF POSTOPERATIVE LIVER AND KIDNEY FUNCTIONS:

The postoperative ALB of the patients in the 2021 group was better than that of patients in the 2020 group, and the difference between the groups was statistically significant (36.66±3.66 vs 34.20±4.13g/L, P<0.05), but the liver and kidney function indicators such as ALT (82.40±60.85 vs 105.96±52.54 umol/L), AST (149.24±108.53 vs 195.71±112.46 umol/L), SCR (65.64±12.22 vs 60.74±14.58 umol/L), and BUN (4.71±1.07 vs 5.24±1.72 mmol/L) were not significantly different (P> 0.05), as shown in Table 5.

COMPARISON OF PATIENT SATISFACTION:

Patient satisfaction of the 2021 group was better than that of the 2020 group, and the difference between the groups was statistically significant (χ2=9.9, P<0.05), as shown in Table 6.

Discussion

POSTOPERATIVE MEDICATION AND MONITORING:

Excessive fluid replacement increases the burden on the heart, increase the incidence of cardiovascular and cerebrovascular complications, and easily leads to intestinal tissue edema, delaying the recovery of gastrointestinal function, and thus prolonging the hospital stay. In the concept of FTS, individualized and precisely controlled infusion is carried out according to the nutritional status of patients, so as to avoid the occurrence of the above situation and achieve rapid recovery [25].

High-temperature damage to liver tumor tissue by radiofrequency ablation inevitably leads to abnormal liver function, and it is easy to destroy a large number of red blood cells in the blood supply of the tumor, release hemoglobin, cause hemoglobinuria, block renal tubules, and lead to renal failure. Therefore, postoperative monitoring of liver and kidney function is necessary. Sodium bicarbonate can prevent acidosis caused by renal damage, increases the alkali content of patients, and regulates the body’s electrolyte balance [26]. In the 2021 group, sodium bicarbonate was routinely used to alkalize urine after surgery to reduce the damage to renal function caused by surgical stress. However, except for the postoperative albumin index, the statistical data did not indicate significant differences in liver and kidney function, which may be due to the small sample size, which is related to the size, number, and basic conditions of the patients undergoing radiofrequency ablation. The absorption of tumor necrotic tissue after ablation can easily cause the patient’s body temperature to rise. The patient’s vital signs should be assessed 24 hours after the operation. Transient abnormalities can be treated symptomatically when the abdominal signs are not obvious, and bedside B-ultrasound should be reviewed. Psychological care is needed to prevent patients from being too anxious and affecting recovery. If the patient has symptoms of hypotension, rapid heart rate, irritability, and peritonitis with tight abdominal muscles, it should be reported to the doctor immediately. If active bleeding is indeed suspected, 2–3 venous channels should be quickly established, hemostasis, blood transfusion, fluid rehydration, and dilatancy treatment should be given according to the doctor’s advice, and preparation for surgery or intervention should be made.

The most intuitive advantage of FTS surgical care is that it can shorten the length of hospital stay, so the discharge plan should be discussed with the patient at the time of hospitalization, and prudently formulating discharge standards and follow-up plans is an important measure to reduce the rate of readmission, ensure patient safety, and increase satisfaction. Since patients will still have varying degrees of perioperative discomfort after discharge, it is necessary to have regularly scheduled return visits, promoting the concept of rapid recovery, and guiding postoperative recovery, and these measures will be understood by the patients and actively cooperated with in most cases [27].

Since FTS nursing is a transition from a “disease-centered” to a “patient-centered” nursing model, through multidisciplinary cooperation, the entire treatment process of patients can be accelerated from multiple links, medical expenses can be saved, and patients’ confidence in overcoming the disease can be enhanced, so that they can return to the familiar social environment as soon as possible, which is conducive to improvement of quality of life [28].

FTS has been applied in many surgical fields, such as abdominal surgery, cardiothoracic surgery, orthopedics, urology, and gynecology [29], but there are few reports on the application of FTS for radiofrequency ablation of liver cancer. Although radiofrequency ablation is a minimally invasive procedure, there are still many problems plaguing patients in the perioperative period. In this paper, by comparing the relevant data of patients treated with radiofrequency ablation of liver cancer in our hospital in the past, it is concluded that the nursing model based on the concept of FTS is superior to traditional nursing.

Several limitations should be mentioned. The fast-track surgery program is commonly used for patients undergoing major surgery, and it has been widely used in many minimally invasive surgeries such as laparoscopic cholecystectomy and laparoscopic hepatectomy. Radiofrequency ablation is a kind of minimally invasive surgery, which is why we used the fast-track surgery program in these patients. Furthermore, this was a retrospective study, reporting clinical practice rather than selected trial patients, which might have led to bias. The 2 groups contained limited samples and were not standardized or strictly matched, so it may not be possible to draw reliable conclusions. Future research needs more high-quality, multi-center, and large-sample randomized controlled trials.

Conclusions

Nursing care using a fast-track surgery approach with early-stage hepatocellular carcinoma patients undergoing first-line treatment with radiofrequency ablation is better than conventional nursing. It reduces the incidence of complications, relieves pain and economic burden of patients, and improves patient satisfaction. Our results demonstrated that it is worthy of application and promotion.