Effect of an ERAS-based pulmonary rehabilitation exercise program on perioperative outcomes in liver resection patients: a prospective study.

Assignment was by odd or even admission sequence, not by a described random number generator or concealed allocation, so the groups may not be comparable. The paper does not report blinding of patients, nurses, or outcome assessors. The intervention was a multi-component nurse-delivered bundle, so the contribution of any single exercise, educational, or monitoring part cannot be separated. Outcomes were measured only at baseline and days 1, 3, and 5, and the authors state there was no long-term follow-up. The authors state the sample size was relatively small and that some pulmonary measures, such as maximal voluntary ventilation and vital capacity percentage, were not included. Psychological outcomes, patient satisfaction, and qualitative feedback were not directly collected. The paper reports lower cost values but says no formal cost-effectiveness analysis was performed. Several table values are reported without units or scale ranges in the supplied text.

No conflicts of interest were declared. Funding came from Wenzhou Science and Technology Bureau and Zhejiang Provincial Natural Fund grants.

Do not read the lung function gains as proof that one exercise component caused them. The intervention was a nurse-delivered bundle added to routine care, and assignment was by admission sequence odd or even, so the contribution of any single part cannot be separated.