Enhanced recovery after surgery for elderly patients with hip fracture during the perioperative period

doi:10.3877/cma.j.issn.2096-0263.2022.01.003

Abstract

Abstract:

Objective

To evaluate the clinical effects of enhanced recovery after surgery (ERAS) forelderly patients with hip fracture during the perioperative period.

Methods

149 elderly patients (≥75 years old) with hip fracture who underwentsurgery were analyzed retrospectivelyfrom July 2013 to October 2016 in Putuo Hospital affiliated to Shanghai University of Chinese Medicine. There were 62 males and 87 females with mean age of 82±5 years. All patients were divided into ERAS group (78 cases) and conventional care group (71 cases) during the perioperative period. The length of postoperative hospital stay, Visualanalogyscore (VAS), postoperative complications and Harris hip score of the two groups were analyzed and compared.

Results

All 149 patients werefollowed up with an average of 1 (6.0±2.3) months. The length of postoperative hospital stay was (7.2±1.2) day in ERAS group and (12.1±1.9) day in conventional care group, (t=2.513, P<0.05). Therewasno significant difference in VAS score between the two groups at 24 h and 48 h after surgery (t=1.761, t=1.598, P>0.05). VAS score of ERAS group at 12 h and 72 h after surgery (2.5±1.3 and 1.2±0.8) was significantly lower than that of conventional care group (3.9±1.6 and 2.7±1.5)(t=2.379, t=2.165, P<0.05)]. Postoperative complication rates of mental disorder andincidence of nausea and vomiting in ERAS group (6.4% and 9.0% respectively) were significantly lower than conventional care group (23.9% and 29.6%) (χ²=9.079, χ²=10.339, P<0.05). There were no significant differences in the rates of pneumonia, DVT, cerebrovascular accident, urinary tract infection and bedsore between two groups (χ²=1.665, χ²=1.232, χ²=0.444, χ²=2.170, χ²=1.091, P>0.05). Harris hip score of ERAS group (63.2±4.8) was significantly higher than than conventional care group (49.2±3.9) (t=2.221, P<0.05) at 1 week after surgery. There was no significant difference in Harris hip score between the two groups at 3 months, 6 months and 12 months after surgery (t=1.187, t=1.098, t=0.813, P>0.05).

Conclusions

The application of ERAS program for elderly patients with hip fracture during the perioperative period can reduce the complication rates of mental disorder and the incidence of nausea and vomiting, accelerate the recovery of the early postoperative hip function and shorten the length of postoperative hospital stay.

Key words: Hip fractures, Aged, Recovery, Perioperation

Wenjun Shi, Peiyang Shang, Xiangyu Cheng, Jixiang Shi, Fuying Liu, Jinhui Pang, Lei Zhang, Shailin Zhang. Enhanced recovery after surgery for elderly patients with hip fracture during the perioperative period[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2022, 08(01): 10-17.

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References 20

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组别	例数	年龄（岁， ±s）	性别（例）男/女	患侧（例）		骨折部位（例）		手术方法（例）		ASA评级（例）		VAS（分， ±s）
组别	例数	年龄（岁， ±s）	性别（例）男/女	左	右	股骨颈	转子间	内固定	关节置换	Ⅱ	Ⅲ	VAS（分， ±s）
加速康复外科组	78	82±6	33/45	41	37	43	35	32	46	29	49	5.1±1.9
传统处理模式组	71	81±5	29/42	34	37	39	32	30	41	28	43	4.9±1.6
χ²/t值		1.278	0.033	0.325		0.001		0.023		0.080		1.288
P值		0.213	0.856	0.569		0.981		0.879		0.777		0.23

组别	例数	年龄（岁， ±s）	性别（例）男/女	患侧（例）		骨折部位（例）		手术方法（例）		ASA评级（例）		VAS（分， ±s）
组别	例数	年龄（岁， ±s）	性别（例）男/女	左	右	股骨颈	转子间	内固定	关节置换	Ⅱ	Ⅲ	VAS（分， ±s）
加速康复外科组	78	82±6	33/45	41	37	43	35	32	46	29	49	5.1±1.9
传统处理模式组	71	81±5	29/42	34	37	39	32	30	41	28	43	4.9±1.6
χ²/t值		1.278	0.033	0.325		0.001		0.023		0.080		1.288
P值		0.213	0.856	0.569		0.981		0.879		0.777		0.23

组别	例数	术后时间（h）
组别	例数	12	24	48	72
加速康复外科组	78	2.5±1.3	1.9±0.9	1.7±1.1	1.2±0.8
传统处理模式组	71	3.9±1.6	2.6±1.4	2.1±1.1	2.7±1.5
t值		2.379	1.761	1.598	2.165
P值		0.016	0.072	0.124	0.038

组别	例数	术后时间（h）
组别	例数	12	24	48	72
加速康复外科组	78	2.5±1.3	1.9±0.9	1.7±1.1	1.2±0.8
传统处理模式组	71	3.9±1.6	2.6±1.4	2.1±1.1	2.7±1.5
t值		2.379	1.761	1.598	2.165
P值		0.016	0.072	0.124	0.038

组别	并发症例数	年龄（岁， ±s）	性别	骨折部位		手术方法		术后12月Harris评分（分， ±s）
组别	并发症例数	年龄（岁， ±s）	男/女	股骨颈	转子间	内固定	关节置换	术后12月Harris评分（分， ±s）
加速康复外科组	17	80±7	7/10	9	8	6	11	81.0±5.1
传统模式处理组	53	81±6	20/33	28	25	22	31	80.2±4.9
χ²/t值		1.310	0.028	0.010		0.019		0.723
P值		0.192	0.762	0.873		0.784		0.516

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