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Impact of modified ERAS protocol implementation on length of stay and complications in elderly hip fracture patients:
Yunzhong Liu1, Guanglin Ou2, Mingdong Xie1
1Department of Orthopedics, The First Affiliated Hospital of Traditional Chinese Medicine of Chengdu Medical College (Xindu Hospital of Traditional Chinese Medicine), Chengdu, Sichuan, 610500, China.
Aim:
Hip fractures in elderly patients pose significant healthcare challenges with high complication rates and prolonged hospital stays. Enhanced Recovery After Surgery (ERAS) protocols have shown promise in various surgical specialties, but their application in elderly hip fracture patients, particularly in Traditional Chinese Medicine (TCM) hospital settings, remains limited.
Methods:
This retrospective before-and-after study was conducted at a TCM hospital from July 2022 to July 2025. A total of 300 elderly hip fracture patients (≥ 65 years) were included: 146 in the control group (July 2022 - October 2023) receiving conventional care and 154 in the ERAS group (February 2024 - July 2025) receiving modified ERAS protocol incorporating TCM elements. Primary outcomes were length of hospital stay and perioperative complications within 30 days. Secondary outcomes included functional recovery [Harris Hip Score (HHS), Modified Barthel Index (MBI)], time to first mobilization, pain scores, and healthcare costs.
Results:
The ERAS group demonstrated significantly shorter length of stay compared with controls (12.38 ± 3.75 vs. 16.24 ± 5.10 days; mean difference 3.86 days, 95% CI: 2.84-4.88; P < 0.001). Total perioperative complications were reduced (7.79% vs. 15.07%; risk difference: -7.28%, 95% CI: -14.5% to - 0.1%; P = 0.047). The ERAS group showed superior functional outcomes with higher HHS and MBI at discharge and 3-month follow-up (all P ≤ 0.002). Time to first mobilization was significantly shorter in the ERAS group (28.73 ± 12.61 vs. 52.64 ± 18.37 h, P < 0.001), and pain scores were significantly lower at 24 h (4.21 ± 1.32 vs. 5.83 ± 1.64) and 72 h postoperatively (2.87 ± 1.14 vs. 4.12 ± 1.39, both P < 0.001). Total hospital costs were lower in the ERAS group (¥22,847 ± 6,216 vs. ¥24,621 ± 6,875, P = 0.020). Multiple regression analysis identified ERAS implementation as the strongest independent predictor of reduced length of stay (β=-3.421, P < 0.001).
Conclusions:
Implementation of a modified ERAS protocol incorporating TCM elements was associated with reduced length of stay, enhanced functional recovery, and lower healthcare costs in elderly hip fracture patients at a single TCM hospital. These improvements were achieved without evidence of increased complications. Multicenter prospective studies are warranted to confirm these findings.