Enhanced Recovery After Surgery (ERAS) Protocol in Geriatric Hip Fractures: An Observational Study

Abstract
Introduction: Geriatric hip fractures are the new global pandemic. It is predicted to reach 7.3-21.3 million
cases worldwide by 2050. Even with optimal care, geriatric patients suffer a higher morbidity and mortality rate when compared with the general population and often demand expensive hospital aftercare. This study aims to assess the implications of the successful adoption of the enhanced recovery after surgery (ERAS) protocol in the management of geriatric hip fractures in an Indian facility. Methods: This is a retrospective study conducted in a tertiary care hospital in India and reported following REporting of studies Conducted using the Observational Routinely collected health Data (RECORD) guidelines. We included all geriatric patients over 60 years of age who were admitted with hip fractures for
surgical management between January 2021 and January 2023. The individual perioperative components of
the ERAS protocol focus on key areas such as preoperative nutritional support, effective multimodal analgesia with optimal pain control, fluid management, and early ostoperative mobilization.Results: Thirty-eight geriatric patients with a mean age of 77.5 (± 9.6) years were included for analysis. Twenty-three patients sustained intertrochanteric fractures and underwent fixation with proximal femur
nailing and the remaining had 15 sustained neck or femur fractures of which 11 underwent hemiarthroplasty
surgery and the remaining four underwent a total hip replacement. The mean time to surgery was 2 (± 0.2)
days. Eighty-two percent (n=31) of the patients were mobilized with a walking frame within a day after surgery and were followed up after discharge with home physiotherapy. The mean time to ambulation was 2 (± 0.62) days. The mean length of stay was 4 (± 1.6) days. We had a 30-day readmission rate of 5.2% (n=2) and a 30-day mortality rate of 5.2% (n=2). The one-year mortality rate was 13% (n=5). Conclusion: Management of geriatric hip fractures requires exceptional interdisciplinary coordination and carefully planned strategies to optimize patient care. With the implementation of the ERAS protocol, we could perceive clinical benefits in terms of early recovery and short length of hospital stay in patients with hip fractures. Further comparative studies are required, which can determine the relative importance of
individual measures in the ERAS protocol and understand their longer-term outcomes in hip fracture surgeries.