Abstract
PurposeEnhanced 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.MethodsWe 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.ResultsAfter 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.ConclusionThe 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.
Highlights
Intertrochanteric femoral fractures (ITF) predominates in the elderly, accounting for 45% of all hip fractures, and the incidence of ITF is increasing with the accelerated aging of the population [1, 2]
The introduction of Enhanced Recovery After Surgery (ERAS) for ITF in our institution has resulted in a significant decrease in length of hospital stay (LOS), alleviated patient pain, promoted early recovery of patient’s hip function while effectively preventing complications, and obtained patient satisfaction
Enhanced Recovery After Surgery (ERAS) is one of the critical concepts leading the development of modern surgery in the twenty-first century, which is first proposed by Kehlet in 1997 [6]
Summary
Intertrochanteric femoral fractures (ITF) predominates in the elderly, accounting for 45% of all hip fractures, and the incidence of ITF is increasing with the accelerated aging of the population [1, 2]. The complications caused by prolonged bed rest in nonoperative patients tend to lead to high disability and mortality rates. Its core component is the integration of perioperative concepts using a series of tools proven effective by evidence-based medicine to intervene in perioperative patients to reduce surgical stress and complications, shorten hospital stays, reduce financial costs, and accelerate postoperative recovery [7, 8]. The concept of accelerated rehabilitation surgery has been increasingly applied in orthopedics, and some scholars have confirmed that the application of ERAS has achieved good results in orthopedics, including the clinical application in the field of artificial joint replacement can reduce postoperative hospitalization time and mortality, increase patient satisfaction, and reduce hospitalization costs [9,10,11]. There is little information about the application of the ERAS concept in ITF
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