Perioperative Care Guided by Enhanced Recovery after Surgery in Older Adults with Intertrochanteric Femoral Fractures: A Prospective Comparative Study.

Abstract

Older adults with intertrochanteric femoral fractures represent a high-risk population in whom perioperative management remains challenging, often leading to delayed recovery and increased complication burden. Enhanced recovery after surgery (ERAS) offers a structured, multidisciplinary approach to optimize perioperative care; however, application of this approach in geriatric orthopedic trauma requires further clarification. This study evaluates a standardized ERAS-guided perioperative care pathway designed to improve clinical efficiency and early functional recovery in routine practice. Using institutional clinical data, 80 patients aged 70 years or older undergoing intramedullary fixation were analyzed under two perioperative care models: a conventional pathway and an ERAS-guided pathway. The pathway incorporated accelerated diagnostic assessment, targeted preoperative optimization, goal-directed anesthesia and fluid management, multimodal analgesia, early oral nutrition, and structured early mobilization. Perioperative efficiency, physiological stability, pain trajectories, functional recovery, and postoperative complications were systematically assessed. Implementation of the ERAS pathway was associated with a shorter admission-to-anesthesia interval (26.3 ± 9.1 vs. 47.8 ± 11.9 h, p < 0.001), reduced hemoglobin decline (16.1 ± 4.9 vs. 21.1 ± 6.1 g/L, p < 0.001), lower postoperative pain scores at 24 h (3.8 ± 0.9 vs. 4.6 ± 1.0, p < 0.001), and a reduced overall complication rate (10.0% vs. 32.5%, p = 0.014). In conclusion, a structured ERAS-guided perioperative pathway is feasible and clinically applicable in older adults with intertrochanteric femoral fractures, providing a reproducible framework that supports optimized perioperative management and facilitates early recovery in routine clinical practice.