Abstract
BACKGROUND: Gastrointestinal (GI) dysfunction is a common postoperative complication in patients after acute type A aortic dissection (ATAAD) surgery. Recent evidence suggests that, in addition to early nutrition and feeding strategies, physiotherapy can help to reduce the incidence of postoperative GI dysfunction. This study aimed to investigate whether GI function after ATAAD open surgery can be recovered through surface gastrointestinal electrical stimulation (SGES). METHODS: This was a prospective, parallel-group, assessor-blind, randomized controlled trial (RCT). A total of 74 participants were included and randomly divided into a control group (CG) and an SGES intervention group (IG) in a 1:1 ratio. The CG received a standardized perioperative management program developed by a multidisciplinary team, based on the principles of enhanced recovery after surgery (ERAS). The IG implemented SGES at ST36, ST25, and two additional GI pacemakers, as well as ERAS. The primary outcome was GI-2 recovery (tolerance of oral diet and passage of stool). Secondary outcomes included the Gastrointestinal Symptom Rating Scale (GSRS), acute gastrointestinal injury ultrasonography (AGIUS), the Gastrointestinal Quality of Life Index (GIQLI), the incidence of constipation and diarrhea, length of stay in the intensive care unit (ICU), and duration of hospitalization. RESULTS: Of the 74 patients in this study, 24.32% were female, with a mean age of 49.61 years. The time to achieve GI-2 in the IG was significantly shorter, 1.9 days, than in the CG (log-rank test, p = 0.01). The GSRS scores in the IG were significantly lower than those in the CG (total scores: 1.2 vs. 1.6; p = 0.001). Moreover, the GIQLI values at all three follow-up visits were significantly higher in the IG group than in the CG group. CONCLUSIONS: To our knowledge, this is the first RCT to investigate the clinical effects of SGES on GI recovery after open-heart surgery for ATAAD. The results provide preliminary evidence supporting the feasibility and therapeutic potential of SGES in a high-risk population. SGES can promote the recovery of GI function, reduce GI-related symptoms, and improve the GI-related quality of life after open heart surgery in patients with ATAAD. CLINICAL TRIAL REGISTRATION: This trial was based on the Consolidated Standards of Reporting Trials (CONSORT) guidelines. This trial was registered in the Chinese Clinical Trial Registry (identifier ChiCTR2300075265, https://www.chictr.org.cn/showproj.html?proj=205523).