{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T10:46:48Z","timestamp":1775818008893,"version":"3.50.1"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The intervention was significantly associated with improved process metric adherence, notably correlating with reduced time to first ambulation (17.8\u00a0\u00b1\u00a08.5\n                      <jats:italic>vs<\/jats:italic>\n                      . 24.3\u00a0\u00b1\u00a09.9 hours, p&amp;lt;0.001) and increased pain assessment compliance (87.6\u00a0\u00b1\u00a05.1%\n                      <jats:italic>vs<\/jats:italic>\n                      . 77.3\u00a0\u00b1\u00a08.2%, p&amp;lt;0.001). This correlated with accelerated recovery, including shorter time to first flatus (59.2\u00a0\u00b1\u00a010.3\n                      <jats:italic>vs<\/jats:italic>\n                      . 71.6\u00a0\u00b1\u00a013.8 hours, p&amp;lt;0.001) and postoperative stay (8.2\u00a0\u00b1\u00a01.8\n                      <jats:italic>vs<\/jats:italic>\n                      . 10.3\u00a0\u00b1\u00a02.2 days, p&amp;lt;0.001). Severe complications (Clavien-Dindo \u2265III) were numerically lower in the intervention group (10.5%\n                      <jats:italic>vs<\/jats:italic>\n                      . 18.6%, p=0.194), with notably lower overall infectious complications. Crucially, the intervention was significantly associated with improved 1-year (84.9%\n                      <jats:italic>vs<\/jats:italic>\n                      . 74.4%) and 2-year RFS (64.9%\n                      <jats:italic>vs<\/jats:italic>\n                      . 43.3%) (log-rank p=0.011). In multivariable analysis, NSI program enrollment remained independently associated with a reduced risk of recurrence (adjusted HR\u00a0=\u00a00.509, 95% CI: 0.314\u20130.824, p=0.006). Exploratory mediation analysis indicated 37.3% of the associated survival benefit might be mediated through reduced hospital stay.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1785140","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T09:46:46Z","timestamp":1775814406000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A structured, indicator-driven quality improvement cycle is associated with improved adherence and outcomes after liver resection for hepatocellular carcinoma"],"prefix":"10.3389","volume":"16","author":[{"given":"Jiao","family":"Xie","sequence":"first","affiliation":[{"name":"Department of Hepatobiliary and Pancreatic Surgery, The Third Affiliated Hospital of Chongqing Medical University (Fangda Hospital)","place":["Chongqing, 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China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiu","family":"Du","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary and Pancreatic Surgery, The Third Affiliated Hospital of Chongqing Medical University (Fangda Hospital)","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.4240\/wjgs.v17.i2.101297","article-title":"Comprehensive influence of individualized nutrition support and nursing strategy on rehabilitation of patients with liver cancer after operation","volume":"17","author":"Zhang","year":"2025","journal-title":"World J Gastrointest Surg"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.21203\/rs.3.rs-117741\/v1","article-title":"Prognostic value of inflammatory and nutritional markers for hepatocellular 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