Implementation of Enhanced Recovery After Surgery (ERAS) protocol for elderly patients receiving surgery for intertrochanteric fracture: a propensity score-matched analysis

Abstract

Purpose Enhanced Recovery After Surgery (ERAS) is a multimodal approach to perioperative care that aims to reduce patient perioperative complications, accelerate patient recovery, and improve patient satisfaction by refining and optimizing all perioperative management processes. By comparing two groups of patients before and after the implementation of ERAS for intertrochanteric fracture (ITF) with a matching analysis of propensity score (PS), we aimed to demonstrate that the implementation of ERAS protocol shortens the length of hospital stay (LOS), reduces pain, decreases the incidence of postoperative complications, and promotes functional recovery of the joint. Methods We selected 2 periods of 1 year, before (n=98patients) and after ERAS implementation (n=92patients). Data were collected on patient demographics, operative and perioperative details, LOS, VAS score, Harris score, and 30-day complications. ERAS-trained nurses are engaged to support patients at each step of the pre/per/postoperative process, including completing a satisfaction survey, with the help of a mobile app. PS analyses were used for dealing with confounding bias in this retrospective observational study. Results After PS matching, the outcomes of 124 well-balanced pairs of patients were compared (conventional vs ERAS). LOS was significantly reduced from 24.3±3.9 to 15.2±2.9 days (P<0.001). With the same preoperative VAS scores, we found that patients in the ERAS group had significantly lower postoperative VAS scores than those in the conventional group at days 3 and 7 (P<0.001), but the difference was not statistically significant at day 14. patients in the ERAS group had higher Harris scores than those in the conventional group at 1 and 3 months, but the difference was not significant at 6 months. In addition, we found that only one patient in the ERAS group developed complications, while nine patients in the conventional group developed different complications. There was no significant difference concerning the satisfaction survey. Conclusion The introduction of ERAS for ITF in our institution has resulted in a significant decrease in LOS, alleviated patient pain, promoted early recovery of patient’s hip function while effectively preventing complications, and obtained patient satisfaction.

Unsupervised Data Mining and Effect of Fast Rehabilitation Nursing Intervention in Fracture Surgery

“…The data in Table 2 showed that the nursing satisfaction score in group R was obviously higher than that of group C, which was 92.35 ± 3.65 points and 2.14 ± 1.25 points, respectively, with statistical differences ( P < 0.05). This shows that rapid rehabilitation nursing intervention is unanimously recognized by patients, which can not only effectively relieve the nurse-patient relationship but also greatly improve the patient's satisfaction with the medical staff care [ 21 , 22 ].…”

Application Effect of Case Management Mode Combined with ERAS in Elderly Patients with Hip Fracture

“…It has the characteristics of continuity, rapidity, professionalism, and comprehensiveness, which can provide more comfortable nursing content [ 17 ]. ERAS includes popularizing joint movement by strengthening the knowledge of hip fracture care for patients and their families before surgery, ensuring patients in good condition during surgery, urging patients to exercise as soon as possible after surgery, formulating scientific and high-quality rehabilitation plan, and accelerating patient recovery after surgery [ 18 ]. In the intervention process of the case management mode combined with ERAS, medical staff implement multimodal analgesia care for patients, self-controlled analgesia through the use of pain-relieving pump, and follow the doctor's instructions to give patients intravenous and oral analgesics, thereby reducing the pain of patients.…”

Enhanced Recovery after Surgery Rehabilitation Protocol in the Perioperative Period of Orthopedics: A Systematic Review

“…After excluding the articles that did not meet the inclusion criteria, a total of 40 articles were included. Of these articles, 11 are for fracture-related procedures [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. There are 14 articles on joint replacement-related surgery [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ] and 15 articles on spine surgery [ 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 ].…”

“… ( A ): Risk of bias assessment in studies. ( B ): Risk of bias assessment in each study [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 ]. …”