Enhanced recovery following neck of femur fractures - improving outcomes : a survey of current perioperative practice.

Abstract

Aims: 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.

Methods: 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.

Results: 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.

Conclusion: 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.