See Abbas, Taylor Lauren A, Rollins Katie E, Hewson David W, Gordon Adam L, Duckworth Andrew D, Griffin Xavier L, Ollivere Ben J
School of Medicine, University of Nottingham, Nottingham, UK.
Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK.
Bone Jt Open. 2025 Sep 8;6(9):1065-1072. doi: 10.1302/2633-1462.69.BJO-2025-0046.R1.
The number of hip fractures is increasing, with significant mortality and morbidity, particularly among frail and comorbid patients. Enhanced recovery after surgery (ERAS) pathways have proven effective in elective orthopaedics, but this has not been investigated in people with hip fractures. This study aimed to identify current perioperative practice and develop a cohesive ERAS pathway tailored for hip fracture patients, to standardize and optimize care.
We conducted a cross-sectional survey-based study across trauma professionals. The survey was disseminated to an expert panel via direct mailing through research collaboratives and social media. Net promoter scores (NPS) were used to quantify survey responses, with a score of over 30 indicating that respondents felt strongly that a particular intervention should be included in the ERAS pathway.
Responses were received from 51 institutions and a variety of trauma professionals. Respondents rated preoperative, perioperative, and postoperative interventions for inclusion in an ERAS pathway. Highly rated preoperative intervention included nerve blockade (NPS = 81) and delirium risk assessment (NPS = 69). Avoidance of intraoperative hypotension (NPS = 45) was the only perioperative intervention scoring above 30. Key postoperative interventions included geriatric review (NPS = 74) and Day 0 mobilization (NPS = 53). Overall, 87.5% of respondents expressed willingness to join a trial comparing ERAS to standard care.
This study highlights the need for a standardized ERAS pathway for people who experience hip fractures. Key recommendations include preoperative optimization, early mobilization, and multidisciplinary input, all of which align with existing ERAS guidelines. Further research should focus on conducting feasibility studies to refine and validate this pathway.
髋部骨折的数量正在增加，伴有显著的死亡率和发病率，尤其是在体弱和患有合并症的患者中。术后加速康复（ERAS）路径已被证明在择期骨科手术中有效，但尚未在髋部骨折患者中进行研究。本研究旨在确定当前围手术期的实践情况，并制定一条为髋部骨折患者量身定制的连贯的ERAS路径，以规范和优化护理。
我们对创伤专业人员进行了一项基于横断面调查的研究。通过研究合作组织和社交媒体直接邮寄的方式，将调查问卷分发给一个专家小组。净促进者得分（NPS）用于量化调查回复，得分超过30表明受访者强烈认为某项特定干预措施应纳入ERAS路径。
收到了来自51个机构和各类创伤专业人员的回复。受访者对纳入ERAS路径的术前、围手术期和术后干预措施进行了评分。评分较高的术前干预措施包括神经阻滞（NPS = 81）和谵妄风险评估（NPS = 69）。避免术中低血压（NPS = 45）是唯一一项得分高于30的围手术期干预措施。关键的术后干预措施包括老年评估（NPS = 74）和术后第0天活动（NPS = 53）。总体而言，87.5%的受访者表示愿意参加一项比较ERAS与标准护理的试验。
本研究强调了为髋部骨折患者制定标准化ERAS路径的必要性。关键建议包括术前优化、早期活动和多学科参与，所有这些都与现有的ERAS指南一致。进一步的研究应侧重于进行可行性研究，以完善和验证该路径。
