Nurse-led non-ICU early rehabilitation after liver transplantation: a quasi-experimental historical-control study
- 1Liver Transplant Center, Organ Transplant Center, Department of General Surgery, West China Hospital of Sichuan University, Chengdu, China
- 2West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
- 3Laboratory of Liver Transplantation, Institute of Organ Transplantation, Key Laboratory of Transplant Engineering and Immunology, NHC, Sichuan University, Chengdu, Sichuan, China
Abstract
BackgroundEarly rehabilitation after liver transplantation is increasingly encouraged, but most programs are implemented after intensive care unit (ICU) stabilization. We evaluated a nurse-led pathway in which selected liver transplant recipients were transferred directly to the general ward after surgery. Because the intervention was introduced sequentially over time, the study was analyzed as a non-randomized historical-control quasi-experiment.MethodsRecovery-timing, device-duration, length-of-stay, and hospitalization-charge analyses were conducted in the 102 recipients who survived to complete postoperative outcome ascertainment (57 intervention and 45 control) and are therefore survivor-conditional. Continuous outcomes were assessed for distributional assumptions and compared using two-sided Mann-Whitney U tests when non-normal. Sparse binary outcomes were analyzed using Fisher's exact test. Multivariable linear regression with HC3 heteroscedasticity-robust standard errors adjusted for age, sex, body mass index, preoperative diagnosis, surgery duration, and log-transformed intraoperative blood loss. Log1p-transformed models were used as sensitivity analyses for skewed outcomes.ResultsCompared with historical controls, recipients treated during the intervention period had earlier initiation of oral intake (median 13.0 vs. 48.0 h, P < 0.001), respiratory training (13.0 vs. 48.0 h, P < 0.001), and first out-of-bed activity (39.0 vs. 72.0 h, P < 0.001), as well as shorter urinary and central venous catheter retention (both P < 0.001). In adjusted models, intervention-period status was associated with earlier initiation of oral intake (adjusted difference −51.76 h, 95% CI −70.71 to −32.82), earlier respiratory training (−56.58 h, 95% CI −83.66 to −29.50), earlier ambulation (−60.48 h, 95% CI −103.24 to −17.72), shorter urinary catheter retention (−85.93 h, 95% CI −114.11 to −57.75), shorter central venous catheter retention (−66.17 h, 95% CI −89.70 to −42.63), and shorter length of stay (−4.48 days, 95% CI −8.23 to −0.73). Multidrug-resistant bacterial infection was numerically lower (3.5% vs. 13.3%) but not statistically significant (RR 0.26, 95% CI 0.06–1.24; Fisher's exact P = 0.134). Total hospitalization charges were lower in the unadjusted comparison but showed no statistically significant adjusted association with the pathway (P = 0.467).ConclusionIn this historical-control quasi-experimental study, implementation of the nurse-led non-ICU transition pathway was associated with earlier achievement of several postoperative rehabilitation milestones and shorter hospital stay after adjustment for measured covariates. Because intervention status was inseparable from calendar period and unmeasured temporal confounding could not be excluded, these findings should be interpreted strictly as associations rather than evidence of direct intervention effects. Prospective multicenter studies with contemporaneous controls and predefined safety criteria are needed before broader implementation.
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BibTeX
@article{xu2026nurseled,
title = {{Nurse-led non-ICU early rehabilitation after liver transplantation: a quasi-experimental historical-control study}},
author = {XiaoFeng Xu and XiaoFeng Xu and Jing Xu and Ting Zeng and Gang Xu and Gang Xu and JiaYin Yang and JiaYin Yang},
journal = {Frontiers in Public Health},
year = {2026},
month = oct,
doi = {10.3389/fpubh.2026.1812156},
url = {https://doi.org/10.3389/fpubh.2026.1812156},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Nurse-led non-ICU early rehabilitation after liver transplantation: a quasi-experimental historical-control study
AU - XiaoFeng Xu
AU - XiaoFeng Xu
AU - Jing Xu
AU - Ting Zeng
AU - Gang Xu
AU - Gang Xu
AU - JiaYin Yang
AU - JiaYin Yang
PY - 2026
DA - 2026/10/23
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.1812156
UR - https://doi.org/10.3389/fpubh.2026.1812156
AB - BackgroundEarly rehabilitation after liver transplantation is increasingly encouraged, but most programs are implemented after intensive care unit (ICU) stabilization. We evaluated a nurse-led pathway in which selected liver transplant recipients were transferred directly to the general ward after surgery. Because the intervention was introduced sequentially over time, the study was analyzed as a non-randomized historical-control quasi-experiment.MethodsRecovery-timing, device-duration, length-of-stay, and hospitalization-charge analyses were conducted in the 102 recipients who survived to complete postoperative outcome ascertainment (57 intervention and 45 control) and are therefore survivor-conditional. Continuous outcomes were assessed for distributional assumptions and compared using two-sided Mann-Whitney U tests when non-normal. Sparse binary outcomes were analyzed using Fisher's exact test. Multivariable linear regression with HC3 heteroscedasticity-robust standard errors adjusted for age, sex, body mass index, preoperative diagnosis, surgery duration, and log-transformed intraoperative blood loss. Log1p-transformed models were used as sensitivity analyses for skewed outcomes.ResultsCompared with historical controls, recipients treated during the intervention period had earlier initiation of oral intake (median 13.0 vs. 48.0 h, P < 0.001), respiratory training (13.0 vs. 48.0 h, P < 0.001), and first out-of-bed activity (39.0 vs. 72.0 h, P < 0.001), as well as shorter urinary and central venous catheter retention (both P < 0.001). In adjusted models, intervention-period status was associated with earlier initiation of oral intake (adjusted difference −51.76 h, 95% CI −70.71 to −32.82), earlier respiratory training (−56.58 h, 95% CI −83.66 to −29.50), earlier ambulation (−60.48 h, 95% CI −103.24 to −17.72), shorter urinary catheter retention (−85.93 h, 95% CI −114.11 to −57.75), shorter central venous catheter retention (−66.17 h, 95% CI −89.70 to −42.63), and shorter length of stay (−4.48 days, 95% CI −8.23 to −0.73). Multidrug-resistant bacterial infection was numerically lower (3.5% vs. 13.3%) but not statistically significant (RR 0.26, 95% CI 0.06–1.24; Fisher's exact P = 0.134). Total hospitalization charges were lower in the unadjusted comparison but showed no statistically significant adjusted association with the pathway (P = 0.467).ConclusionIn this historical-control quasi-experimental study, implementation of the nurse-led non-ICU transition pathway was associated with earlier achievement of several postoperative rehabilitation milestones and shorter hospital stay after adjustment for measured covariates. Because intervention status was inseparable from calendar period and unmeasured temporal confounding could not be excluded, these findings should be interpreted strictly as associations rather than evidence of direct intervention effects. Prospective multicenter studies with contemporaneous controls and predefined safety criteria are needed before broader implementation.
SN - 2296-2565
ER -