Development and Evaluation of Clinical Practice Guidelines for Patients Undergoing Hepatectomy

Background: Liver cancer is a major public health problem in Thailand due to its high incidence and mortality. Although hepatectomy is a potentially curative treatment, it is a complex procedure with a high risk of postoperative complications, necessitating a structured and systematic approach to care. Objectives: This study aimed to develop a clinical practice guideline (CPG) for patients with liver cancer undergoing hepatectomy and to evaluate the feasibility of its implementation in relation to outcomes for healthcare providers, the organization, and patients. Methods: This implementation research was conducted in three phases: (1) an evidence-triggered phase, (2) an evidence-supported phase, and (3) an evidence-observed phase. The CPG covered five stages of care: preoperative, intraoperative, postoperative, discharge planning, and post-discharge follow-up. It was implemented through a multidisciplinary approach, with an advanced practice nurse (APN) facilitating adherence to Enhanced Recovery After Surgery (ERAS) components. Data were analyzed using descriptive statistics. Results: Healthcare personnel demonstrated high adherence to the CPG and reported high feasibility of implementation. After implementation, favorable trends were observed in postoperative complications, length of hospital stay, hospitalization costs, and patient satisfaction compared with the historical pre-implementation period. The CPG also appeared to support clearer care standards and multidisciplinary coordination. Conclusions: The developed CPG was feasible and contextually appropriate for ERAS-based hepatectomy care in this setting. Preliminary findings suggest favorable trends in care processes and selected outcomes. Larger controlled studies with longer follow-up are needed to determine effectiveness and sustainability.