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 vs . 24.3 ± 9.9 hours, p<0.001) and increased pain assessment compliance (87.6 ± 5.1% vs . 77.3 ± 8.2%, p<0.001). This correlated with accelerated recovery, including shorter time to first flatus (59.2 ± 10.3 vs . 71.6 ± 13.8 hours, p<0.001) and postoperative stay (8.2 ± 1.8 vs . 10.3 ± 2.2 days, p<0.001). Severe complications (Clavien-Dindo ≥III) were numerically lower in the intervention group (10.5% vs . 18.6%, p=0.194), with notably lower overall infectious complications. Crucially, the intervention was significantly associated with improved 1-year (84.9% vs . 74.4%) and 2-year RFS (64.9% vs . 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.