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Interrupted time series analysis of a digital nursing decision support system for postoperative lymphorrhea
Xiu Du1,2, Mei Duan3, Yu Yang3
1Department of Head and Neck Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
Abstract:
Postoperative lymphorrhea is a common complication of thyroid cancer surgery that prolongs hospital stays and raises medical costs. This study aimed to evaluate the association between a digital nursing decision support system (DNDSS)-assisted nursing and the incidence of postoperative lymphorrhea in thyroid cancer patients, and clarify the correlation between routine clinical indicators and lymphorrhea outcomes to provide evidence for optimizing clinical nursing strategies. A single-center retrospective observational interrupted time series (ITS) study was conducted on 1286 thyroid cancer patients who underwent surgery at Hubei Cancer Hospital from January 2019 to June 2024, divided into a pre-intervention group (January 2019 to December 2021, routine nursing, n = 612) and a post-intervention group (January 2022 to June 2024, DNDSS-assisted nursing, n = 674). ITS analysis was used to assess changes in lymphorrhea incidence, and multivariate logistic regression analysis to screen its risk factors. Baseline data were comparable between groups (all P > .05). ITS analysis showed the implementation of DNDSS was associated with a significant decrease in postoperative lymphorrhea incidence (21.08% vs 8.46%, P < .001), with a level change coefficient of -0.126 (95% confidence interval [CI]: -0.168 to -0.084, P < .001) and a slope change coefficient of -0.003 (95% CI: -0.005 to -0.001, P = .002). Preoperative hypoalbuminemia (<35 g/L), total neck dissection, prolonged operation time (>180 minutes), poor drainage tube nursing compliance and lack of personalized nutritional support were independent risk factors (all P < .05), while DNDSS-assisted nursing was an independent protective factor (odds ratio = 0.324, 95% CI: 0.215-0.489, P < .001). DNDSS is associated with a significantly reduced incidence of postoperative lymphorrhea in thyroid cancer patients, serving as an effective clinical nursing tool. Clinical nursing should focus on high-risk patients and improve nursing compliance and personalized nutritional support to further reduce lymphorrhea risk.
