Analysis in risk factors of intestinal obstruction afterradical total cystectomy with robotic assistance and related nursing interventions

  Objective  To analyze the risk factors of intestinal obstruction after radical cystectomy under the assistance of robots and its nursing interventions.

  Methods  Clinical data of 102 patients treated with robotic radical cystectomy under the assistance of robots was analyzed. According to presentation of postoperative intestinal obstruction, they were divided into postoperative intestinal obstruction group (n=18) and postoperative non-intestinal obstruction group (n=84). Their age, gender, body mass index(BMI), smoking history, drinking history, and hypertension history, history of diabetes, history of previous abdominal surgery, historyof preoperative chemotherapy, preoperative serum albumin levels, surgical methods, operation time, intraoperative blood transfusion, intraoperative blood loss, 24 hour pelvic drainage, postoperative TNM staging, average daily activity, the time to get out of bed after the first operation and the retention time of the pelvic drainage tube after the operation were compared in the two groups. The risk factors of postoperative intestinal obstruction were analyzed by univariate and multivariate analysis.

  Results  Pelvic drainage volume 24 h after surgery and average daily activity after surgery in the intestinal obstruction group were significantly less than those in the non-intestinal obstruction group, and the retention time of pelvic drainage tube was significantly longer than that in the non-intestinal obstruction group (P < 0.05). Multivariate regression analysis showed that low pelvic drainage volume 24 h after surgery (OR=0.978, 95%CI, 0.957~0.999, P=0.039) and low postoperative average daily activity (OR=0.822, 95%CI, 0.707~0.955, P=0.011) were independent risk factors for the occurrence ofintestinal obstruction.

  Conclusion  Poor drainage, long-term retention of the pelvic drainage tube and less postoperative activity are easy to cause postoperative intestinal obstruction in robotic-assisted radical cystectomy. Therefore, encouraging patients to get out of bed in early period after surgery, keeping the drainage tube unobstructed and implementing personalized activity plan will help reduce the occurrence of postoperative intestinal obstruction.