Association between nursing execution and postoperative recovery following laparoscopic benign gynecologic surgery: a prospective observational cohort study

Enhanced Recovery After Surgery (ERAS)-based perioperative care is widely implemented in gynecologic laparoscopy, yet the real-world execution of nursing practices remains highly variable, potentially contributing to differences in postoperative pain control, recovery quality, and length of stay. This study systematically quantified multidimensional nursing execution and examined its association with key postoperative outcomes.

In this single-center prospective observational cohort, 339 women undergoing laparoscopic surgery for benign gynecologic conditions were enrolled. Nursing execution was assessed across four ERAS-related dimensions-preoperative education, early mobilization, pain management execution, and VTE prevention-each scored from 0 to 10 and categorized into tertiles (high, medium, low). The primary outcomes were moderate-to-severe postoperative pain (NRS ≥ 4 within 48 h) and prolonged length of stay (LOS > 3 days). Multivariable regression models were used to adjust for demographic and perioperative covariates.

A total of 339 patients were included and classified into high (n = 112), medium (n = 118), and low (n = 109) nursing execution groups with comparable baseline characteristics. Higher execution was associated with substantially lower odds of moderate-to-severe pain (adjusted OR = 0.34, 95% CI: 0.18-0.63) and prolonged LOS. Complication rates, including postoperative nausea and vomiting and urinary retention, decreased progressively with higher execution levels. Functional recovery improved in a dose-response pattern: high-execution patients had significantly higher QoR-15 scores (+6.18 points vs. low execution, p < 0.001) and greater satisfaction (+0.82 points, p < 0.001). Sensitivity and subgroup analyses confirmed the robustness of the associations.

Nursing execution is a measurable and modifiable factor that significantly influences postoperative recovery in laparoscopic gynecologic surgery. Higher execution of ERAS-based nursing care was associated with less pain and fewer complications, faster recovery, and shorter hospitalization. Improving execution quality may offer an efficient and practical approach to strengthening ERAS performance in routine practice.