A structured, indicator-driven quality improvement cycle is associated with improved adherence and outcomes after liver resection for hepatocellular carcinoma.

[PURPOSE] Despite established perioperative guidelines for hepatocellular carcinoma (HCC) resection, inconsistent implementation hinders optimal recovery. This study evaluated clinical outcomes associated with a structured, Nursing-Sensitive Indicator (NSI)-driven quality improvement program designed to ensure reliable execution of evidence-based practices.

[PATIENTS AND METHODS] We leveraged a cohort of 172 patients undergoing curative liver resection at The Third Affiliated Hospital of Chongqing Medical University from May 2019 to June 2024. An NSI-driven program featuring systematic monitoring, alert-triggered care bundles, and weekly audit/feedback was implemented. Program patients (Intervention, n=86) were compared to a historical usual-care cohort (Control, n=86) after 1:1 propensity score matching. Primary outcomes included perioperative process compliance and short-term recovery metrics (complications, length of stay). Secondary outcomes included 1-year recurrence-free survival (RFS) and patient-reported outcomes.

[RESULTS] The intervention was significantly associated with improved process metric adherence, notably correlating with reduced time to first ambulation (17.8 ± 8.5 . 24.3 ± 9.9 hours, p<0.001) and increased pain assessment compliance (87.6 ± 5.1% . 77.3 ± 8.2%, p<0.001). This correlated with accelerated recovery, including shorter time to first flatus (59.2 ± 10.3 . 71.6 ± 13.8 hours, p<0.001) and postoperative stay (8.2 ± 1.8 . 10.3 ± 2.2 days, p<0.001). Severe complications (Clavien-Dindo ≥III) were numerically lower in the intervention group (10.5% . 18.6%, p=0.194), with notably lower overall infectious complications. Crucially, the intervention was significantly associated with improved 1-year (84.9% . 74.4%) and 2-year RFS (64.9% . 43.3%) (log-rank p=0.011). In multivariable analysis, NSI program enrollment remained independently associated with a reduced risk of recurrence (adjusted HR = 0.509, 95% CI: 0.314-0.824, p=0.006). Exploratory mediation analysis indicated 37.3% of the associated survival benefit might be mediated through reduced hospital stay.

[CONCLUSION] Implementing a structured NSI-driven quality management program was significantly associated with higher perioperative care fidelity, faster functional recovery, and better recurrence-free survival after HCC resection. This framework provides an effective mechanism for translating evidence-based guidelines into reliable routine practice, potentially correlating with favorable long-term oncological outcomes.