Enhanced Recovery Nursing for Delirium and Functional Recovery After Femoral Neck Fracture Surgery in Older Adults

Postoperative delirium and impaired rehabilitation are major challenges in elderly femoral neck fracture patients. Enhanced recovery nursing (ERN) protocols emphasizing early mobilization and cognitive support may mitigate these complications.

This study evaluated the impact of a perioperative ERN model on delirium incidence, sleep quality, recovery milestones, and long-term functional outcomes.

In a retrospective observational study, 254 patients (≥65 years) undergoing hemiarthroplasty or total hip arthroplasty for femoral neck fractures were allocated to conventional care (n = 116) or ERN groups (n = 138) based on treatment period. Outcomes included delirium incidence (Confusion Assessment Method), sleep quality (Pittsburgh Sleep Quality Index), time to first ambulation, hospital stay, Harris Hip Score, and 36-Item Short Form Survey (SF-36) quality of life at 1 to 12 months postoperatively.

The ERN group showed significantly lower cumulative delirium incidence (6.5% vs. 19.8%; risk difference = -13.3%, 95% confidence incidence [CI]: -20.1% to -6.5%, p = .002), shorter time to ambulation (mean difference [MD] = -1.7 days, 95% CI: -2.2 to -1.2), and hospital stay (MD = -1.6 days, 95% CI: -2.3 to -0.9; both p < .001). Sleep quality improved significantly across all time points (p < .001). Long-term functional recovery was superior in the ERN group, evidenced by higher Harris scores (12-month MD = 4.7, 95% CI: 3.1-6.3) and SF-36 scores (12-month MD = 6.3, 95% CI: 3.9-8.7) at all intervals.

The ERN model significantly reduced delirium, accelerated recovery, and improved long-term function and quality of life, supporting its integration into routine perioperative care for elderly femoral neck fracture patients.