Nurse led postoperative interventions in adult cardiac surgery: a systematic review

Background Specialised cardiac surgical nurses play a central role in postoperative management, providing continuous monitoring, clinical interventions, patient education, and coordination of multidisciplinary care to support guideline informed holistic care to achieve high-quality outcomes. Previous reviews of perioperative or surgical nursing have typically focused on single interventions, specific risk factors or broader populations, rather than cardiac surgery specifically in the acute post-operative period. There is also considerable variation in the scope of practice for specialised cardiac surgical nurses across hospitals, nationally and internationally, with education, competencies and policies differing between institutions and countries. A comprehensive synthesis of nurse-led inpatient interventions in cardiac surgery is therefore needed to inform evidence-based nursing practice, enable cardiac surgical nurses to work to their full scope and potential, and support the development of a consensus statement on optimal nurse-led care in this setting. Purpose To identify nurse-led clinical interventions evaluated in randomised controlled trials (RCT) for adults who had undergone cardiac surgery and assess the effectiveness of these interventions on postoperative clinical and patient-reported outcomes during the acute inpatient phase. Methods A systematic review was undertaken according to an a priori protocol using Joanna Briggs Institute methodology and PRISMA guideline for reporting. The review protocol was registered with PROSPERO. Eligible studies were RCT of adult (≥18 years) cardiac surgery, nurse-led inpatient interventions implemented immediately post-surgery and prior to discharge. Six databases were searched from inception to June 2025. Results Of 2,690 records, 19 RCT were eligible, representing 13 countries, and 3,142 participants. Risk of bias varied, with only two low risk trials. Interventions were grouped into six domains: behavioural support; temperature management and comfort strategies; pain and symptom management; wound care and infection prevention; respiratory and pulmonary function; and postoperative recovery, mobilisation, and hydration. Across these domains, nurse-led interventions were generally feasible, safe, and positively affected patient comfort, physiological stability, symptom relief, and aspects of functional recovery. Conclusion Nurse-led inpatient interventions contribute meaningfully to in-patient postoperative recovery in cardiac surgery, although the broader cardiac surgical nursing scope is underrepresented in RCT. This review provides a foundation for developing further high-quality research, peer-reviewed interdisciplinary practice guidelines, and strengthening the scope and recognition of cardiac surgical nursing as a distinct specialty.