Effect of enhanced recovery after surgery on perioperative management of elderly patients with intertrochanteric fractures_West China Medical Journal

Authors：

LIU Jiaxin ^1,2 , CHEN Li ^1,2 , ZHANG Xiang ^1,2 , GAO Feng ^1,2 , XIANG Zhou ¹ ,  DUAN Xin ¹

1. Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

DUAN Xin, Email: dxbaal@hotmail.com

Keywords：

Enhanced recovery after surgery; Elderly; Intertrochanteric fractures; Perioperative management; Functional rehabilitation

DOI：

10.7507/1002-0179.202008122

Video：

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Objective To explore the clinical effect of applying the concept of enhanced recovery after surgery (ERAS) to the perioperative management of elderly patients with intertrochanteric fractures.Methods The clinical data of 64 elderly patients with intertrochanteric fractures admitted to West China Hospital of Sichuan University from January 2016 to December 2017 were retrospectively analyzed. Among them, 32 patients admitted from January to December in 2017 were in ERAS group, and 32 patients admitted from January to December 2016 were in control group. The control group used conventional orthopedic perioperative management measures, and the ERAS group combined the ERAS concept on the basis of conventional treatment measures for perioperative management. The incidence of perioperative complications, Visual Analogue Scale score, modified Barthel Index score, inpatient satisfaction and length of hospital stay were compared between the two groups.Results There was no significant difference in age, gender, American Society of Anesthesiologists grade, combined disease, modified Barthel Index or Visual Analogue Scale score at admission, or time from injury to surgery between the two groups (P>0.05). The total incidence of perioperative complications (12.5% vs. 37.5%) and length of hospital stay [(8.09±2.33) vs. (10.41±3.63) d] in the ERAS group were lower than those in the control group (P<0.05). The Visual Analogue Scale scores of the two groups of patients before operation, on the first day and the third day after operation were lower than those at admission (P<0.05). The comparison between the two groups at each time point showed that the Visual Analogue Scale scores of patients in the ERAS group were lower than those in the control group before operation, on the first day and the third day after operation, and the differences were statistically significant (P<0.05). The modified Barthel Index scores of the two groups of patients on the third day, and 1 month, 3 months and 6 months after operation showed a rising trend with time. The modified Barthel Index scores of the ERAS group were better than those of the control group on the third day, and 1 month and 3 months after operation (P<0.05). There was no significant difference between the two groups 6 months after operation (P>0.05). The hospitalization satisfaction score of the ERAS group was 95.56±5.12, which was higher than that of the control group (92.84±5.62), and the difference was statistically significant (P<0.05).Conclusions The implementation of ERAS perioperative management for elderly patients with intertrochanteric fractures may reduce the incidence of perioperative complications, relieve patient pain, promote the short-term recovery of activities of daily living of patients, improve the inpatient satisfaction and shorten the length of hospital stay.

Citation： LIU Jiaxin, CHEN Li, ZHANG Xiang, GAO Feng, XIANG Zhou, DUAN Xin. Effect of enhanced recovery after surgery on perioperative management of elderly patients with intertrochanteric fractures. West China Medical Journal, 2021, 36(9): 1210-1215. doi: 10.7507/1002-0179.202008122 Copy

1.	Abrahamsen B, van Staa T, Ariely R, et al. Excess mortality following hip fracture: a systematic epidemiological review. Osteoporos Int, 2009, 20(10): 1633-1650.
2.	孙家元, 张英泽. 老年髋部骨折围手术期处理. 国际骨科学杂志, 2013, 34(1): 11-14, 31.
3.	Bhandari M, Swiontkowski M. Management of acute hip fracture. N Engl J Med, 2017, 377(21): 2053-2062.
4.	Hu F, Jiang C, Shen J, et al. Preoperative predictors for mortality following hip fracture surgery: a systematic review and meta-analysis. Injury, 2012, 43(6): 676-685.
5.	Hershkovitz A, Pulatov I, Brill S, et al. Can hip-fractured elderly patients maintain their rehabilitation achievements after 1 year?. Disabil Rehabil, 2012, 34(4): 304-310.
6.	中华医学会外科学分会, 中华医学会麻醉学分会. 加速康复外科中国专家共识及路径管理指南(2018版). 中国实用外科杂志, 2018, 38(1): 1-20.
7.	Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth, 1997, 78(5): 606-617.
8.	孙天胜, 沈建雄, 刘忠军, 等. 中国脊柱手术加速康复——围术期管理策略专家共识. 中华骨与关节外科杂志, 2017, 10(4): 271-279.
9.	周宗科, 翁习生, 曲铁兵, 等. 中国髋、膝关节置换术加速康复——围术期管理策略专家共识. 中华骨与关节外科杂志, 2016, 9(1): 1-9.
10.	Heller GZ, Manuguerra M, Chow R. How to analyze the Visual Analogue Scale: myths, truths and clinical relevance. Scand J Pain, 2016, 13: 67-75.
11.	王赛华, 施加加, 孙莹, 等. 简体版改良Barthel指数在脑卒中恢复期中的信度与效度研究. 中国康复, 2020, 35(4): 179-182.
12.	屈俊宏, 宁宁, 李佩芳, 等. 基于加速康复外科的骨科心理睡眠管理模式构建及效果评价. 华西医学, 2018, 33(9): 1168-1172.
13.	Jin F, Chung F. Minimizing perioperative adverse events in the elderly. Br J Anaesth, 2001, 87(4): 608-624.
14.	Roche JJ, Wenn RT, Sahota O, et al. Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ, 2005, 331(7529): 1374.
15.	Pedersen SJ, Borgbjerg FM, Schousboe B, et al. A comprehensive hip fracture program reduces complication rates and mortality. J Am Geriatr Soc, 2008, 56(10): 1831-1838.
16.	Friedman SM, Mendelson DA, Bingham KW, et al. Impact of a comanaged Geriatric Fracture Center on short-term hip fracture outcomes. Arch Intern Med, 2009, 169(18): 1712-1717.
17.	Reguant F, Arnau A, Lorente JV, et al. Efficacy of a multidisciplinary approach on postoperative morbidity and mortality of elderly patients with hip fracture. J Clin Anesth, 2019, 53: 11-19.
18.	Liu VX, Rosas E, Hwang J, et al. Enhanced recovery after surgery program implementation in 2 surgical populations in an integrated health care delivery system. JAMA Surg, 2017, 152(7): e171032.
19.	Grigoryan KV, Javedan H, Rudolph JL. Orthogeriatric care models and outcomes in hip fracture patients: a systematic review and meta-analysis. J Orthop Trauma, 2014, 28(3): e49-e55.
20.	Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg, 2017, 152(3): 292-298.
21.	Veziant J, Raspado O, Entremont A, et al. Large-scale implementation of enhanced recovery programs after surgery. A francophone experience. J Visc Surg, 2017, 154(3): 159-166.
22.	Slim K. Fast-track surgery: the next revolution in surgical care following laparoscopy. Colorectal Dis, 2011, 13(5): 478-480.
23.	Sanzone AG. Current challenges in pain management in hip fracture patients. J Orthop Trauma, 2016, 30(Suppl 1): S1-S5.
24.	Soffin EM, Gibbons MM, Ko CY, et al. Evidence review conducted for the agency for healthcare research and quality safety program for improving surgical care and recovery: focus on anesthesiology for total hip arthroplasty. Anesth Analg, 2019, 128(3): 454-465.
25.	Soffin EM, YaDeau JT. Enhanced recovery after surgery for primary hip and knee arthroplasty: a review of the evidence. Br J Anaesth, 2016, 117(suppl 3): iii62-iii72.
26.	Bell KE, von Allmen MT, Devries MC, et al. Muscle disuse as a pivotal problem in sarcopenia-related muscle loss and dysfunction. J Frailty Aging, 2016, 5(1): 33-41.
27.	Vogler CM, Sherrington C, Ogle SJ, et al. Reducing risk of falling in older people discharged from hospital: a randomized controlled trial comparing seated exercises, weight-bearing exercises, and social visits. Arch Phys Med Rehabil, 2009, 90(8): 1317-1324.
28.	Palm H, Teixidor J. Proximal femoral fractures: can we improve further surgical treatment pathways?. Injury, 2015, 46(Suppl 5): S47-S51.
29.	Langenhan R, Trobisch P, Ricart P, et al. Aggressive surgical treatment of periprosthetic femur fractures can reduce mortality: comparison of open reduction and internal fixation versus a modularprosthesis nail. J Orthop Trauma, 2012, 26(2): 80-85.
30.	Pfeufer D, Zeller A, Mehaffey S, et al. Weight-bearing restrictions reduce postoperative mobility in elderly hip fracture patients. Arch Orthop Trauma Surg, 2019, 139(9): 1253-1259.
31.	龙也, 李浪, 王通, 等. 老年转子间骨折术后早期功能锻炼的效果研究. 华西医学, 2018, 33(9): 1124-1127.
32.	Knauf T, Buecking B, Hack J, et al. Development of the Barthel Index 5 years after hip fracture: results of a prospective study. Geriatr Gerontol Int, 2019, 19(8): 809-814.
33.	黎介寿, 江志伟. 加速康复外科的临床意义不仅仅是缩短住院日. 中华消化外科杂志, 2015, 14(1): 22-24.
34.	李庭, 周雁, 孙旭, 等. 缩短创伤骨科择期手术患者围手术期禁食水时间的前瞻性队列研究. 中华创伤骨科杂志, 2018, 20(4): 312-317.
35.	金占萍, 朱迎春, 王哲洋, 等. 老年髋部骨折手术患者围术期营养风险与营养摄入现况调查. 中华现代护理杂志, 2016, 22(36): 5240-5242.

1. Abrahamsen B, van Staa T, Ariely R, et al. Excess mortality following hip fracture: a systematic epidemiological review. Osteoporos Int, 2009, 20(10): 1633-1650.
2. 孙家元, 张英泽. 老年髋部骨折围手术期处理. 国际骨科学杂志, 2013, 34(1): 11-14, 31.
3. Bhandari M, Swiontkowski M. Management of acute hip fracture. N Engl J Med, 2017, 377(21): 2053-2062.
4. Hu F, Jiang C, Shen J, et al. Preoperative predictors for mortality following hip fracture surgery: a systematic review and meta-analysis. Injury, 2012, 43(6): 676-685.
5. Hershkovitz A, Pulatov I, Brill S, et al. Can hip-fractured elderly patients maintain their rehabilitation achievements after 1 year?. Disabil Rehabil, 2012, 34(4): 304-310.
6. 中华医学会外科学分会, 中华医学会麻醉学分会. 加速康复外科中国专家共识及路径管理指南(2018版). 中国实用外科杂志, 2018, 38(1): 1-20.
7. Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth, 1997, 78(5): 606-617.
8. 孙天胜, 沈建雄, 刘忠军, 等. 中国脊柱手术加速康复——围术期管理策略专家共识. 中华骨与关节外科杂志, 2017, 10(4): 271-279.
9. 周宗科, 翁习生, 曲铁兵, 等. 中国髋、膝关节置换术加速康复——围术期管理策略专家共识. 中华骨与关节外科杂志, 2016, 9(1): 1-9.
10. Heller GZ, Manuguerra M, Chow R. How to analyze the Visual Analogue Scale: myths, truths and clinical relevance. Scand J Pain, 2016, 13: 67-75.
11. 王赛华, 施加加, 孙莹, 等. 简体版改良Barthel指数在脑卒中恢复期中的信度与效度研究. 中国康复, 2020, 35(4): 179-182.
12. 屈俊宏, 宁宁, 李佩芳, 等. 基于加速康复外科的骨科心理睡眠管理模式构建及效果评价. 华西医学, 2018, 33(9): 1168-1172.
13. Jin F, Chung F. Minimizing perioperative adverse events in the elderly. Br J Anaesth, 2001, 87(4): 608-624.
14. Roche JJ, Wenn RT, Sahota O, et al. Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ, 2005, 331(7529): 1374.
15. Pedersen SJ, Borgbjerg FM, Schousboe B, et al. A comprehensive hip fracture program reduces complication rates and mortality. J Am Geriatr Soc, 2008, 56(10): 1831-1838.
16. Friedman SM, Mendelson DA, Bingham KW, et al. Impact of a comanaged Geriatric Fracture Center on short-term hip fracture outcomes. Arch Intern Med, 2009, 169(18): 1712-1717.
17. Reguant F, Arnau A, Lorente JV, et al. Efficacy of a multidisciplinary approach on postoperative morbidity and mortality of elderly patients with hip fracture. J Clin Anesth, 2019, 53: 11-19.
18. Liu VX, Rosas E, Hwang J, et al. Enhanced recovery after surgery program implementation in 2 surgical populations in an integrated health care delivery system. JAMA Surg, 2017, 152(7): e171032.
19. Grigoryan KV, Javedan H, Rudolph JL. Orthogeriatric care models and outcomes in hip fracture patients: a systematic review and meta-analysis. J Orthop Trauma, 2014, 28(3): e49-e55.
20. Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg, 2017, 152(3): 292-298.
21. Veziant J, Raspado O, Entremont A, et al. Large-scale implementation of enhanced recovery programs after surgery. A francophone experience. J Visc Surg, 2017, 154(3): 159-166.
22. Slim K. Fast-track surgery: the next revolution in surgical care following laparoscopy. Colorectal Dis, 2011, 13(5): 478-480.
23. Sanzone AG. Current challenges in pain management in hip fracture patients. J Orthop Trauma, 2016, 30(Suppl 1): S1-S5.
24. Soffin EM, Gibbons MM, Ko CY, et al. Evidence review conducted for the agency for healthcare research and quality safety program for improving surgical care and recovery: focus on anesthesiology for total hip arthroplasty. Anesth Analg, 2019, 128(3): 454-465.
25. Soffin EM, YaDeau JT. Enhanced recovery after surgery for primary hip and knee arthroplasty: a review of the evidence. Br J Anaesth, 2016, 117(suppl 3): iii62-iii72.
26. Bell KE, von Allmen MT, Devries MC, et al. Muscle disuse as a pivotal problem in sarcopenia-related muscle loss and dysfunction. J Frailty Aging, 2016, 5(1): 33-41.
27. Vogler CM, Sherrington C, Ogle SJ, et al. Reducing risk of falling in older people discharged from hospital: a randomized controlled trial comparing seated exercises, weight-bearing exercises, and social visits. Arch Phys Med Rehabil, 2009, 90(8): 1317-1324.
28. Palm H, Teixidor J. Proximal femoral fractures: can we improve further surgical treatment pathways?. Injury, 2015, 46(Suppl 5): S47-S51.
29. Langenhan R, Trobisch P, Ricart P, et al. Aggressive surgical treatment of periprosthetic femur fractures can reduce mortality: comparison of open reduction and internal fixation versus a modularprosthesis nail. J Orthop Trauma, 2012, 26(2): 80-85.
30. Pfeufer D, Zeller A, Mehaffey S, et al. Weight-bearing restrictions reduce postoperative mobility in elderly hip fracture patients. Arch Orthop Trauma Surg, 2019, 139(9): 1253-1259.
31. 龙也, 李浪, 王通, 等. 老年转子间骨折术后早期功能锻炼的效果研究. 华西医学, 2018, 33(9): 1124-1127.
32. Knauf T, Buecking B, Hack J, et al. Development of the Barthel Index 5 years after hip fracture: results of a prospective study. Geriatr Gerontol Int, 2019, 19(8): 809-814.
33. 黎介寿, 江志伟. 加速康复外科的临床意义不仅仅是缩短住院日. 中华消化外科杂志, 2015, 14(1): 22-24.
34. 李庭, 周雁, 孙旭, 等. 缩短创伤骨科择期手术患者围手术期禁食水时间的前瞻性队列研究. 中华创伤骨科杂志, 2018, 20(4): 312-317.
35. 金占萍, 朱迎春, 王哲洋, 等. 老年髋部骨折手术患者围术期营养风险与营养摄入现况调查. 中华现代护理杂志, 2016, 22(36): 5240-5242.

West China Medical Journal

Effect of enhanced recovery after surgery on perioperative management of elderly patients with intertrochanteric fractures

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