Sci Rep. 2026 Jul 5. doi: 10.1038/s41598-026-59887-9. Online ahead of print.
ABSTRACT
Craniomaxillofacial (CMF) reconstruction is interdisciplinary, requiring precise coordination between neurosurgeons, oral and maxillofacial surgeons, and nursing teams. Despite its importance, standardized interdisciplinary nursing protocols for neurosurgical patients undergoing CMF reconstruction are lacking, leading to variable care quality and increased complications. This study aimed to evaluate the association between standardized interdisciplinary nursing protocols and clinical outcomes in this patient population. This study aimed to evaluate adherence to interdisciplinary nursing procedures, identify nursing-related risk factors, and explore the association between standardized protocols and clinical outcomes. This multicenter retrospective pre-test/post-test study included 152 patients from five tertiary hospitals treated between 2018 and 2023. Patients were divided into a pre-optimization group (n = 76) and a post-optimization group (n = 76). We applied propensity score matching (1:1 nearest-neighbor, caliper 0.2 SD) to balance baseline characteristics and multilevel mixed-effects models to account for center-level clustering. Data on neurosurgical nursing records such as postoperative infection prevention, position management, swallowing function assessment via Kubota Drinking Test, oral and maxillofacial prosthodontic nursing records, and clinical outcomes were extracted and analyzed. The overall compliance rate for interdisciplinary nursing was associated with significant improvement in the post-optimization group compared to the pre-optimization group (81.6% vs. 42.1%, p < 0.001; Cohen’s h = 0.80, 95% CI: 0.52-1.08). In propensity score-matched analyses (n = 128), standardized protocols remained associated with reduced implant-related infections (OR = 0.38, 95% CI: 0.16-0.91, p = 0.031) and shorter swallowing recovery (mean difference = -4.6 days, 95% CI: -7.8 to -1.4, p = 0.006; Cohen’s d = 1.69). In the full cohort, standardized protocols were associated with direction-consistent reductions in implant-related infections (18.4% vs. 7.9%, p = 0.029; Bonferroni-adjusted p = 0.232) and swallowing function recovery (14.2 ± 3.1 days vs. 9.1 ± 2.5 days, p = 0.012; Bonferroni-adjusted p = 0.096). In continuous compliance analysis, each 10% increase in protocol adherence was associated with a 24% reduction in infection risk (OR = 0.76, 95% CI: 0.65-0.89, p < 0.001) and a 0.58-day reduction in swallowing recovery time (p < 0.001). Patient satisfaction scores were significantly higher in the post-optimization group (4.2 ± 0.5 vs. 3.5 ± 0.7, p = 0.001), which survived Bonferroni correction (adjusted alpha = 0.00625). Multivariate analysis identified non-compliance with oral care (OR = 3.26), delayed rehabilitation training (OR = 2.89), and lack of specialized nurse training (OR = 2.54) as independent factors associated with infections. Six Sigma optimization further improved prosthetic cleaning stability and reduced process defects by 72.3%. Standardized interdisciplinary nursing protocols were associated with improved procedure compliance and enhanced patient satisfaction, which survived correction for multiple comparisons. Direction-consistent but statistically exploratory associations were observed for reduced implant-related infections and accelerated swallowing recovery. While the retrospective design limits causal inference, these findings provide a foundation for developing interdisciplinary nursing guidelines and inform future prospective research in this complex patient population.
PMID:42402655 | DOI:10.1038/s41598-026-59887-9
