ABSTRACT
Objective:To explore the efficacy of enhanced recovery after surgery (ERAS) in the perioperative treatment of elderly patients with intertrochanteric fracture in a primary hospital.Methods:Retrospectively analyzed were the data of 104 elderly patients with intertrochanteric femoral fracture who had been treated by fixation with proximal femoral nail antirotation (PFNA) at Joint & Trauma Surgery, Shangyu People's Hospital of Shaoxing from January 2017 to January 2019. According to whether the ERAS concept was applied perioperatively, the patients were divided into 2 groups. In the ERAS treatment group of 53 cases, there were 27 males and 26 females with an age of (72.7±1.5) years. By the AO classification, 27 cases were type 31-A1, 16 cases were type 31-A2, and 10 cases were type 31-A3. Internal diseases were complicated in 37 cases. The time from injury to operation was (65.8±3.9) h. In the conventional treatment group of 51 cases, there were 31 males and 20 females with an age of (72.6±1.5) years. By the AO classification, 21 cases were type 31-A1, 19 cases were type 31-A2, and 11 cases were type 31-A3. Internal diseases were complicated in 37 cases. The time from injury to operation was (111.5±5.9) h. The postoperative pain visual analogue scale (VAS), hospital stay, complications, Harris hip score at the last follow-up, and one-year mortality were compared between the 2 groups.Results:Except for the time from injury to operation, there was no significant difference in the other preoperative general data between the 2 groups, showing comparability ( P>0.05). All the 104 patients were followed up for 12 to 24 months (average, 14.8 months) after operation. The VAS pain score [(3.2±1.2) points], hospital stay [(6.6±2.2) d], complication rate [5.7% (3/53)], and hip Harris score at the last follow-up [(90.7±1.3) points] in the ERAS treatment group were significantly better than those in the conventional treatment group [(3.9±1.0) points, (12.7±1.8) d, 19.6% (10/51), and (86.5±3.8) points] ( P<0.05). There was no significant difference in the one-year mortality between the ERAS treatment group [18.9% (10/53)] and the conventional treatment group [27.5% (14/51)] ( P>0.05). No such complications were followed up as injury to nerve or blood vessel, wound infection, fracture nonunion or femoral head necrosis in this cohort. Conclusion:In the perioperative treatment of elderly patients with femoral intertrochanteric fracture in a primary hospital, compared with conventional treatment, application of ERAS concept can shorten the patients' hospital stay, reduce the incidence of postoperative complications, achieve rapid recovery, and improve the patients' satisfaction.