Nurse-led non-ICU early rehabilitation after liver transplantation: a quasi-experimental historical-control study
Year: 2026
Type: article
Abstract: Background Enhanced recovery after liver transplantation depends heavily on coordinated nursing care, but early rehabilitation is commonly initiated after intensive care unit (ICU) stabilization. We evaluated a nurse-led pathway in which selected liver transplant recipients bypassed routine postoperative ICU transition and received protocolized early rehabilitation on the general ward. Methods This single-center quasi-experimental study compared 57 recipients treated after pathway implementation (January-June 2026) with 45 historical controls receiving conventional ICU-transition care (July-December 2025). Primary outcomes included recovery milestones, invasive-device retention, complications and multidrug-resistant organism (MDRO) infection. Secondary outcomes were length of stay and total hospitalization cost. Non-normally distributed outcomes were compared using Mann-Whitney U tests. Adjusted analyses used multivariable linear regression with HC3 robust standard errors. Results The intervention group had earlier feeding (median 13.0 vs 48.0 h), respiratory training (13.0 vs 48.0 h) and first out-of-bed activity (39.0 vs 72.0 h), and shorter urinary and central venous catheter retention (all P < 0.001 in unadjusted analyses). After adjustment for age, sex, body mass index, diagnosis, surgery duration and intraoperative blood loss, the pathway remained associated with earlier feeding, respiratory training and ambulation, shorter urinary and central venous catheter retention, and shorter length of stay. Total hospitalization cost was not significantly associated with the pathway after adjustment. MDRO infection was numerically lower (3.5% vs 13.3%), but the difference was not statistically significant (Fisher exact P = 0.134). Conclusions A nurse-led non-ICU transition pathway was associated with earlier achievement of key postoperative recovery milestones, reduced exposure to selected invasive devices and shorter hospital stay. Because the study used sequential historical controls, the findings should be interpreted as associations rather than causal effects. Prospective multicenter studies with contemporaneous controls are warranted.
Source: Frontiers in Public Health
Authors: Jing Xu, Xiaofeng Xu, Ting Zeng, Gang Xu, Jiayin Yang
Institution: West China Hospital of Sichuan University
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7223327240