General Data Analysis
Age
The patients included in this survey were between 40 to 67 years old, among those 45 to 49 years old patients were the majority with a total of 97, accounting for 48.5%. (See Table 1 for details)
Table 1 The distribution of the patients' age
Age
|
40-44
|
45-49
|
50-54
|
55-59
|
60-64
|
65-69
|
Number of cases(Case)
|
27
|
97
|
48
|
17
|
9
|
2
|
Proportion (%)
|
13.50
|
48.50
|
24.00
|
8.50
|
4.50
|
1.00
|
Basic diseases and surgical history
36 out of the 200 patients were associated with various basic diseases, among them 4 were gastrointestinal diseases, accounting for 2% of the total. 61 out of the 200 patients had a history of various surgeries, including 49 cases involving pelvic and abdominal cavity surgery, accounting for 24.5%.
Major diseases of surgical treatment
The main disease of surgical treatment in 200 patients was uterine fibroids with a total of 131 cases, accounting for 65.5%; followed by adenomyosis, attachment lesions, endometrial lesions, cervical intraepithelial neoplasia, complete hydatidiform mole. (See Table 2 for details)
Table 2
Distribution of major diseases in surgical treatment
Disease name | Uterus Fibroids | Myopathy endometrium | Cervical epithelium | Internal tumor attachment | Lesion completeness | Hydatidiform mole |
Number of cases(Case) | 131 | 37 | 10 | 6 | 15 | 1 |
Proportion (%) | 65.50 | 18.50 | 5.00 | 3.00 | 7.50 | 0.50 |
Anesthesia period, Surgery period, Postoperative exhaust time, Postoperative defecation time
The patient’s anesthesia period in surgery varied from 1.25 to 5.25 hours; the surgery period were from 1.0 to 5.0 hours; the longest postoperative exhaust time (from the end of anesthesia to the first postoperative exhaust time, the same below) was 59.50 hours while the shortest was 12.03 hours; the longest postoperative defecation time was 98.83 hours and the shortest was 19.67 hours. (See Table 3 for details)
Table 3
Anesthesia period, surgery period, Postoperative exhaust and defecation time
| Anesthesia period | Surgery Period | Exhaust time | Defecation time |
Average (hour) | 3.20 ± 0.92 | 2.46 ± 0.76 | 26.69 ± 8.70 | 46.92 ± 15.41 |
Maximum (hour) | 5.25 | 5.0 | 59.50 | 98.83 |
Minimum value (hour) | 1.50 | 1.0 | 12.03 | 19.67 |
Postoperative hospital stay
The minimum of postoperative hospital stay was 3 days, and the longest was 14 days. The postoperative hospital stay was mainly 5 or 6 days, accounting for 25.5% and 30.5% separately. The cases of postoperative hospital stay less than 7 days accounted for 87%. (See Table 4 for details)
Table 4
Distribution of postoperative hospital stay
Postoperative hospital stay(day) | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 |
Number of cases (case) | 9 | 28 | 51 | 61 | 25 | 11 | 6 | 1 | 3 | 2 | 1 | 2 |
Proportion (%) | 4.5 | 14.0 | 25.5 | 30.5 | 12.5 | 5.5 | 3.0 | 0.5 | 1.5 | 1.0 | 0.5 | 1.0 |
Comparison between the traditional gastrointestinal motility evaluation index and the scale of the total score
The three traditional indicators of postoperative exhaustion, postoperative defecation, and postoperative bowel sound recovery status were compared with the scale of the total score. Table 5 shows that there were 29 patients who have not been vented on the first day after surgery. The scores of the scale were “normal” with 14 cases and “poor” with 15 cases, suggesting that clinical intervention was required for those who have not been vented on the first day after surgery; 171 cases vented on the first day after surgery and 159 of them recovered “good”, suggesting that those patients should not be intervened temporarily regardless of postoperative bowel movements but observation required; All patients who were included in the observation were exhausted on the second day, 199 cases were classified as “good”, suggesting that those patients did not require clinical intervention with or without defecation, only 1 case was rated as “general” and the others were all recovered of "good", suggesting that only one person should be given appropriate intervention to promote gastrointestinal motility recovery.
In Table 6, it can be seen that the postoperative defecation patient scale scores were all "good", suggesting that patients with postoperative bowel movements can be considered to have good gastrointestinal function recovery. There are still 2 cases who had no bowel movements on the third day after surgery, but the scale were all "good", suggesting that these two people did not require clinical intervention, and all patients had bowel movements within 4 days after surgery.
In Table 7, it can be seen that there were 97 cases whose bowel sounds recovered to normal on the first day after surgery, and 9 of them were classified as “normal”, suggesting that some patients should be appropriately intervened to promote gastrointestinal motility recovery. There were 3 cases classified as “poor”, suggesting that although a minority of patients recovered to normal bowel sounds after surgery, certain interventions were required to promote their gastrointestinal motility recovery.
Table 5
Comparison of postoperative exhaustion and scale scores
| Postoperative exhaust situation | Number of people (n) | Scale scores (x̅ ±S) |
scale classification | Good (n) | Normal (n) | Poor (n) |
the first day after surgery | No exhaust | 29 | 54.14 ± 7.78 | 0 | 14 | 15 |
Exhausted | 171 | 86.14 ± 9.27 | 159 | 11 | 1 |
The second day after surgery | No exhaust | 0 | 0 | 0 | 0 | 0 |
Exhausted | 200 | 97.05 ± 6.45 | 199 | 1 | 0 |
Table 6
Comparison of postoperative defecation and scale scores
| Postoperative defecation | Number of people (n) | Scale scores (x̅±S) | scale classification |
Good (n) | Normal (n) | Poor (n) |
the first day after surgery | no defecation | 145 | 75.24 ± 11.77 | 104 | 25 | 16 |
Have a bowel movement | 55 | 98.00 ± 4.43 | 55 | 0 | 0 |
The second day after surgery | no defecation | 32 | 82.97 ± 7.26 | 31 | 1 | 0 |
Have a bowel movement | 168 | 99.73 ± 1.57 | 168 | 0 | 0 |
The third day after surgery | no defecation | 2 | 82.5 ± 2.50 | 2 | 0 | 0 |
Have a bowel movement | 198 | 100 ± 0 | 198 | 0 | 0 |
The forth day after surgery | no defecation | 0 | 0 | 0 | 0 | 0 |
Have a bowel movement | 200 | 100 ± 0 | 0 | 0 | 0 |
Table 7
Comparison of postoperative bowel sound recovery and scale scores
| Postoperative recovery of bowel sounds | Number of people (n) | Scale scores (x̅±S) | scale classification |
Good (n) | Normal (n) | Poor (n) |
the first day after surgery | None | 2 | 45.00 ± 10.00 | 0 | 0 | 2 |
weakened | 101 | 74.50 ± 11.74 | 74 | 16 | 11 |
Normal | 97 | 89.54 ± 11.95 | 85 | 9 | 3 |
The second day after surgery | None | 0 | 0 | 0 | 0 | 0 |
weakened | 16 | 83.44 ± 7.23 | 15 | 1 | 0 |
Normal | 184 | 98.23 ± 4.81 | 184 | 0 | 0 |
Characteristics evaluation results of gastrointestinal motility evaluation specifications after perioperative period
Feasibility
Acceptance rate
This study was conducted by a gynaecologist as an investigator with the one-on-one questionnaire. The questionnaire was finished between every one specialist and one patient. The questionnaire was issued in 202 copies and 202 were recovered. The recovery rate was 100%.
Completion rate
Since this scale is for gynecological specialist on-site interview and physical examination, and then filled out by specialist doctors, only 2 copies of the scale with a completion rate of less than 95%, the total completion rate is about 99.01%. In the analysis, 200 scales were used after deleting those two copies.
Completion time
The minimum completion time of this scale is 61 seconds, the longest is 120 seconds, and the average time is 95.49 seconds. Therefore, the completion time of the scale is (95.49 ± 16.69) seconds.
Based on the data above, the recovery rate of the gastrointestinal motility after perioperative period scale was 100%, the completion rate of the scale was 99.01%, and the completion time of the scale was (95.49 ± 16.69) seconds. From the data above, the scale is of good acceptability.
Reliability
Cronbach's Alpha
The total Cronbach's Alpha coefficient of this scale is 0.519, and the Alpha coefficient calculated after standardization is 0.620, which is between 0.60 and 0.65, suggesting that the reliability of this scale is among the acceptable range. (See Table 8)
Table 8 Total Cronbach alpha coefficient of the scale
Cronbach’s Alpha
|
Cronbach's Alpha Based on Standardized Items
|
N of Items
|
0.516
|
0.620
|
6
|
Split-half reliability coefficient
Spearman-Brown formula is used to calculate the split-half reliability coefficient of the scale. The items are divided into two parts according to odd and even order. The unequal-length Spearman-Brown is 0.706, split-half reliability is between 0.7 and 0.8, indicating that the split-half reliability of the scale is better (see Table 9).
Table 9
split-half reliability of the scale
| N of Items | Cronbach’s Alpha | Spearman-Brown Equal Length | Coefficient Unequal Length |
Part 1 | 3 | 0.250 | 0.706 | 0.706 |
Part 2 | 3 | 0.098 | | |
Note: Part 1: anal exhaust, bowel sounds, nausea; Part 2: anal defecation, abdominal pain, vomit. |
Sensitivity analysis of the item
The sensitivity analysis of the item is to remove one of the items in the scale and then calculate its Cronbach's Alpha coefficient. If the value of the coefficient is larger, the influence of the item on the relevant statistics is greater. Thus, this item is the first consideration of adjustment [96]. The sensitivity of the item “vomiting” in this scale is low and is an item that can be considered for optimization after the perioperative gastrointestinal motility scale. (See Table 10)
Table 10
Sensitivity analysis of item
| Remove the mean of the total score of the current item scale | Remove the variance of the total score of the current item scale. | Remove the Cronbach’s Alpha coefficient of the total score of the current item scale. |
1. Anal exhaust | 63.325 | 104.090 | 0.414 |
2. Anal defecation | 76.300 | 119.407 | 0.471 |
3. Bowel sound | 69.250 | 166.018 | 0.419 |
4. Abdominal pain | 62.125 | 159.909 | 0.427 |
5. Disgust | 65.675 | 200.421 | 0.512 |
6. Vomit | 65.450 | 207.585 | 0.531 |
Validity
Face validity and content validity
During the preparation of this scale, the Chinese and foreign databases were reviewed, including CNKI, CQVIP, Wanfang, China Biomedical Literature Database, Medline, Pubmed, EMBASE, etc.. A large number of Chinese and Western medical literatures were obtained, among which there is a total of 1640 articles were retrieved and read, among which 687 articles related to postoperative gastrointestinal motility evaluation index. Relevant evaluation indicators were extracted and entered into the database to obtain 9 symptoms and signs.
This evaluation specification has gradually formed through eight rounds of expert consultation: after the first round of expert consultation, bowel sounds, anal exhaust, anal defecation, abdominal distension, nausea and vomiting were the main clinical evaluation indicators; after the second round of experts consultation, the subjective and objective indicators were scored according to the 20-point scale, and the scores of “bloating” were greater than “disgusting” and “vomiting”, and “anal exhaust” was greater than “intestinal sounds” and “anal defecation”; after the third round of expert consultation, the index of each indicator and the corresponding score are determined, and the comprehensive evaluation criteria are determined as “good” (80-100 points), “normal” (60-79 points), and “poor” (0-59 points); the evaluation criteria indicators formed by the fourth and fifth rounds of expert consultation (ie, preliminary evaluation specifications); and the sixth to eighth round of expert consultations formed the draft standard for evaluation. The draft was evaluated by a small sample clinical evaluation related disciplines such as surgery, gynecology, orthopedics and etc.. The data show that the evaluation results of the standard are consistent with the evaluation results of postoperative exhaust and defecation indicators. At the same time, it is possible to scientifically evaluate the comprehensive recovery of gastrointestinal function in patients after surgery, including not only the objective indicators of postoperative anal exhaust, defecation, and the time of bowel sounds recovering to normal, but also the recovery of subjective indicators such as nausea, vomit, and abdominal pain. In the case, the recovery of gastrointestinal function reflected is more comprehensive and comprehensive. This form was submitted to the Provincial Quality Supervision Bureau after being approved by the expert group. Finally, it was approved by the Provincial Quality Supervision Bureau on April 16, 2015 and officially implemented on July 16, 2015.
Structural validity
KMO test and Bartlett's spherical test
From Table 11, the KMO (Kaiser-Meyer-Olkin) value of the scale is 0.581, which is greater than 0.5, indicating the validity of the factor analysis. According to Kaiser (1974), the scale is suitable for factor analysis; in Bartlett's spherical test, the value of the test is 181.005, the free degree is 15, P < 0.001, indicating that the correlation coefficient matrix of the factor is a non-integral matrix, which can extract the least factor at the same time and explain most of the variance, suggesting validity. (See Table 11 for details)
Table 11
KMO test of the scale and Bartlett's spherical test
Kaiser-Meyer-Olkin Measure of Sampling Adequacy | Bartlett's Test of Sphericity |
Approx. Chi-Square | df | P |
0.581 | 181.005 | 15 | <0.001 |
Factor analysis
The principal component analysis method and the maximum variance rotation method were used to analyze the factors. It can be seen from the following table that the factor is extracted according to the characteristic value > 1, two common factors are extracted, and the cumulative contribution rate is 56.331% (see Table 12 for details). After the revolve of the shaft, they were combined into two types of factors, the subjective symptom factor and the objective symptom factor, covering the main contents of the scale, suggesting that the structure of the scale is good (see Table 13). As can be seen from Table 16, the first common factor is the subjective symptom factor (including abdominal pain, nausea, vomit), and the second common factor is the objective symptom factor (including exhaust, defecation, bowel sounds).
Table 12
Factor analysis of the scale
Component | Initial Eigenvalues | Extraction Sums of Squared Loadings | Rotation Sums of Squared Loadings |
Total | % of Variance | Cumulative % | Total | % of Variance | Cumulative % | Total |
1 | 2.116 | 35.273 | 35.273 | 2.116 | 35.273 | 35.273 | 1.859 |
2 | 1.263 | 21.057 | 56.331 | 1.263 | 21.057 | 56.331 | 1.734 |
3 | 0.889 | 14.819 | 71.150 | | | | |
4 | 0.833 | 13.883 | 85.032 | | | | |
5 | 0.480 | 7.994 | 93.026 | | | | |
6 | 0.418 | 6.974 | 100.000 | | | | |
Table 13
Common factor extraction results after maximal variance of all factors revolved
Item | factor 1 | factor 2 |
Postoperative exhaust | | 0.515 |
Postoperative defecation | | 0.814 |
Postoperative abdominal pain score | 0.740 | |
Postoperative nausea score | 0.801 | |
Postoperative vomiting score | 0.606 | |
Postoperative bowel sounds | | 0.788 |
Extraction Method: Principal Component Analysis. Rotation Method: Promax with Kaiser Normalization. a. Rotation converged in 3 iterations. |
Analysis of reactivity
The paired rank sum test was performed on the total scores of the post-treatment and post-treatment scales of the postoperative patients. The original hypothesis indicates that the median of the difference between pre-treatment (ie, the first test total score on the first postoperative day) and the post-treatment (ie, the first, second and third postoperative day) was equal to 0, and P < 0.001 was calculated. The original hypothesis was rejected, indicating that there are significant statistical differences of the total score before treatment and the first day, the second day, and the third day after treatment (see Table 14–18 for details).
Table 14
The paired rank sum test of the third test of before treatment and the first day after treatment
N | Test Statistic | Standard Error | Standardized Test Statistic | P |
200 | 780.00 | 66.23 | 5.89 | < 0.001 |
Table 15
The paired rank sum test of the third test of before treatment and the second day after treatment
N | Test Statistic | Standard Error | Standardized Test Statistic | P |
200 | 10270.00 | 487.51 | 10.51 | < 0.001 |
Table 16
The paired rank sum test of the third test of before treatment and the third day after treatment
N | Test Statistic | Standard Error | Standardized Test Statistic | P |
200 | 12246.00 | 553.55 | 11.06 | < 0.001 |
Table 17
The paired rank sum test of the third test of the first day and second day after treatment
N | Test Statistic | Standard Error | Standardized Test Statistic | P |
200 | 9284.50 | 455.26 | 10.16 | < 0.001 |
Table 18
The paired rank sum test of the third test of the second day and third day after treatment
N | Test Statistic | Standard Error | Standardized Test Statistic | P |
200 | 630.00 | 59.81 | 5.27 | < 0.001 |
Standardized effect size (ES)
It is the ratio of the absolute value of the mean difference between before and after treatment to the standard deviation before treatment. It is calculated that the standardized effect value of the total score of this scale is 1.32, indicating that the scale has a high degree of reactivity.
Standardized response mean (SRM)
It is the ratio of the mean of the differences before and after treatment to the standard deviation of before and after treatment. It is calculated that the mean standard response of the main symptom scores of this scale is 1.32, which also indicates that the scale has a high degree of reactivity.