Review for 10.1186/s12876-025-03854-7 (2025)

Title: Application effect of Standardized Nursing Process of abdominal drainage tube in
cholelithiasis: a single-center retrospective cohort study
Version: 1 Date: 07 Mar 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-While a single-center study offers detailed insights into a specific institution's practice, its
findings may not be generalizable to other settings with different patient populations, healthcare
resources, or management protocols. Multi-center studies would help enhance the external
validity of the results.
-Since this is a retrospective cohort study, the lack of randomization between the SNP and non-
SNP groups may lead to selection bias. Patients who received SNP care may differ from those
who did not, which could confound the results.
-The study does not mention whether potential confounding factors (e.g., comorbidities, other
medications, or surgical variations) were controlled for in the analysis. This oversight could
affect the interpretation of the findings, as these factors may influence both drainage tube
complications and recovery outcomes.
-While the follow-up period of three months allows for some insight into post-surgical
recovery, it may not be long enough to capture the full range of complications or long-term
effects associated with drainage tube management. A longer follow-up might provide more
comprehensive data on patient outcomes.
-While the SNP is described in detail, the study does not clarify how adherence to the
standardized process was monitored or ensured. It’s essential to have clarity on how consistently
the SNP was implemented across patients and whether variations in care could have influenced
the outcomes.
-The data collection process is fairly extensive, but there could be more detail on how data
was collected and managed. For instance, were there any challenges or inconsistencies in the
collection process that might affect the validity of the results?
-While the sample size is not explicitly stated, it’s crucial that the study is adequately powered to
detect meaningful differences between groups. Without information on sample size calculation,
it's difficult to assess whether the study had sufficient statistical power to detect significant
effects.
-It’s not clear if the outcomes were assessed in a blinded manner, which could introduce bias in
reporting or interpreting results. Blinding could reduce subjective bias, especially in assessing
outcomes like VAS scores and patient satisfaction.
-The discussion acknowledges the limitations of a single-center study but does not fully explore
the potential impact of this limitation on the external validity of the results. The reader is left to
wonder how much these findings can be generalized to other institutions or regions with different
patient demographics, healthcare protocols, or resources.
-The study uses patient satisfaction and pain scores (VAS scores) as key outcome measures.
While these are important, the subjectivity of these outcomes could introduce bias. The
discussion does not address how this subjectivity was controlled or whether it could affect the
reliability of the conclusions, especially regarding patient comfort and satisfaction.
-Although complications related to drainage tubes (e.g., dislodgement, infection, and poor
drainage) are discussed, there is no detailed analysis of how the SNP specifically mitigated these
issues compared to the non-SNP group. More data on specific complication rates would help
strengthen the argument for the effectiveness of SNP.
-The SNP process is described in the methodology, but the discussion could have further
explored how exactly the SNP was implemented in practice and whether there were any
challenges or variances in adherence. Were nurses consistently following the protocol? Were
there any barriers to the full implementation of SNP?
-The study design is inherently limited by the retrospective nature of data collection. While the
authors note this limitation, they could have further discussed how the lack of randomization
or prospective data could affect the findings. Future studies could benefit from a prospective
randomized controlled trial to more definitively assess the effectiveness of SNP in managing
drainage tubes.