Volume 100 ·  Issue 37 ·  2020

To Explore the current status and risk factors of perioperative allogenic red blood cell transfusion following enhanced recovery hip and knee joint arthroplasty.

Patients who have taken their primary unilateral total hip and knee arthroplasty (THA, TKA) or simultaneous primary THA were retrospectively included from January, 2019 to December, 2019 in West China Hospital. The baseline characteristics were compared between patients with allogeneic transfusion and those without. And logistic regression were used to analyze the risk factors of perioperative allogeneic red blood cell transfusion.

A total of 2 034 patients (2072 arthroplasties) were included, 705 males and 1 329 females, aged (60±24) years. Of all, 1 137 patients received primary THA (38 simultaneous THA), 897 patients received primary unilateral TKA. Eleven (0.54%) patients received allogeneic red blood cell transfusion, and the mean volume was (2.6±1.2) U. Deep venous thrombosis occurred in 2 patients (0.09%) undergoing primary TKA. The transfusion rate in primary THA patients was 0.79% (9/1 137), and 0.22% (2/897) in TKA. Lower preoperative hemoglobin level (P=0.041) and more hematological comorbidities (P=0.005) were detected in transfused patients. And logistic analysis further revealed that preoperative substandard hemoglobin level was the most important risk factor for transfusion (OR=5.663, P=0.018).

Under the intervention of enhanced recovery after surgery concept and modern blood management strategies, the transfusion requirement has been significantly reduced following primary joint arthroplasty. Pre-operative hemoglobin level should be an important threshold for perioperative blood management.

To develop a fast track transfer to intensive care unit (ICU) for the perioperative high-risk elderly patients after hip fracture surgery and analyze the preliminary clinical effect of the application.

From January 2014 to December 2017, before the application of postoperative fast track transfer to ICU, the clinical data of 195 elderly patients with hip fracture were included in a retrospective analysis. Among 195 hip fracture patients, 18 were transferred to ICU post operation (non-fast track group). Multivariate logistic regression analysis was applied to investigate relevant risk factors for transferring to ICU after hip fracture surgery. Based on risk factors acquired from the analysis and clinical experience, the fast track transfer to ICU for the perioperative high-risk elderly patients after hip fracture surgery was constructed according to the preliminary and experiential criteria. From January 2018 to December 2019, the clinical data of 70 patients (fast track group) who were transferred to ICU after hip fracture surgery through the fast track were collected and compared with non-fast track group.

Multivariate regression analysis revealed that American Society of Anesthesiologists classification(≥Ⅲ) (OR=4.260, 95%CI:1.157-15.683, P=0.029), pre-hospital stage (≥48 h) (OR=4.301, 95%CI:1.212-15.266, P=0.024), hemoglobin concentration at admission(<90 g/L) (OR=7.979, 95%CI:1.936-32.889, P=0.004), coronary heart disease as one comorbidity(OR=6.063, 95%CI:1.695-21.693, P=0.006) were independent risk factors for transferring to ICU after hip fracture surgery. There were no significant difference in gender, age, fracture type, hemoglobin concentration at admission and time of pre-hospital stage between the non-fast track group and fast track group(all P>0.05). However, the number of comorbidities in the fast track group was significantly higher than that in the non-fast track group (Z=-1.995, P=0.046). The time to surgery, postoperative hospital stay, and length of hospital stay in fast track group were all significantly less than those in non-fast track group (Z=-2.121, -2.726, -3.130, all P<0.05). Also, there were fewer medical consultations needed and fewer patients who stayed in ICU more than or equal to 2 nights in fast track group than that in non-fast track group(allP<0.05). There were no significant difference in the rate of patients who transferred from the general ward to ICU after transferring from ICU to the general ward, the proportion of patients who received more than or equal to 4 departments, operation time, hospitalization expense, mortality during hospitalization, 30-day mortality and 90-day mortality after operation between the two groups(allP>0.05).

The fast track constructed in this study can reduce time to surgery, postoperative hospitalization stay and length of hospitalization stay for the perioperative high-risk elderly patients with hip fractures and is a specific clinical application of eras concept based on multidisciplinary team.

To explore the clinical effect of enhanced recovery after surgery (ERAS) for the elderly patients with femoral neck fracture.

A total of 92 elderly patients with femoral neck fracture who received hemiarthroplasty from July 2018 to December 2018 in Beijing Jishuitan Hospital were enrolled in this study. The average age of the participants was (75±6) years, including 31 males and 61 females, and 72(78.3%) of the patients complicated with comorbidity. According to the perioperative management method, the patients were divided into the observational group (47 cases with ERAS) and the control group (45 cases with normal management). The data related to operation, hospitalization, complication and nursing satisfaction were compared between the 2 groups. The visual analogue scale (VAS) was used for pain evaluation. The Harris scores for hip joint and EQ-5D index scores were applied to evaluate the clinical outcomes. The follow-up were performed periodically for 3 months. The measurement data in accordance with normal distribution and homogeneity of variance were compared with t test.

All the surgeries completed successfully and no patient died during perioperative period. Compared with the control group, the operation rate in 48 hours (χ²=17.781, P<0.01), bed days (Z=-4.987, P<0.01), and medical costs (Z=-4.315, P<0.01) favored that in the observational group. The incidence of complication and nursing satisfaction showed no significant difference between the two groups (31.1% vs 14.9%, 86.7% vs 95.7%, χ²=3.432, 1.380, both P>0.05). The perioperative VAS score was lower in the observational group. The Harris scores were higher in the observational group after 1 months (t=4.458, P<0.01), however the quality of life for 2 groups was similar at all time points (t=1.293, 1.227, both P>0.05).

ERAS can improve hip function and reduce the hospital stays and medical costs for patients underwent HA operation.

To investigate the characteristics of modified Oxford grading scale (MOS) and pelvic floor surface electromyography (sEMG) based on Glazer protocol in patients with stress urinary incontinence (SUI), and analyze the correlation between the two methods.

This study was a cross-sectional survey. A total of 212 subjects in May 2019 were enrolled and divided into SUI group (n=61) and non-SUI group (n=151) based on the commonly used 3 incontinence questions (3IQ). MOS test and sEMG parameters were measured by the same rehabilitator. The sEMG parameters included the mean and variation coefficient in the prerest phase, the maximum and relaxation time of 5 rapid contractions, the mean and variability of EMG in 10 s tonic contraction phase, the mean and variability of EMG in 60 s endurance contraction phase, and the mean and variability of EMG in postrest phase. The differences of the above parameters between SUI group and non-SUI group were compared, the logistic regression and Spearman method were used to analyze the correlation between MOS and sEMG parameters.

The prevalence of SUI was 28.8%(61/212) in community, body mass index and delivery mode were the risk factors (all P<0.05). The MOS of the SUI group and the non-SUI group were 3 (2,3) and 3 (3,4), respectively, with significant difference (Z=-2.58, P=0.010). Among the sEMG parameters of SUI group and non-SUI group, the maximum values of phasic contractions were 23.12 (13.65, 37.89), 30.68 (20.28, 47.02) μV, the mean of tonic contractions were 14.32 (9.62, 21.49), 17.65 (12.05, 26.35) μV, and the mean of endurance contractions were 12.78(7.88, 18.76), 16.55(11.13, 22.40) μV, respectively, with statistical significance ( Z=-2.34, -2.37, -3.20, all P<0.05). The multivariate logistic regression revealed that both the variation coefficient of tonic contractions (OR=157.86, 95%CI: 1.99-12 595.51, P<0.05) and the amplitude of endurance contractions(OR=1.11, 95%CI: 1.03-1.19, P<0.05) were correlated with SUI. The tonic contractions amplitude had the tendency to be related to SUI (OR=0.95, 95%CI: 0.09-1.00, P<0.05). In all subjects, MOS was correlated with the maximum value of rapid contractions, average value of tonic contractions and average value of endurance contractions (r=0.516, 0.503, 0.464, all P<0.05). In SUI group (r=0.510, 0.442, 0.385, all P<0.05), and non-SUI group (r=0.495, 0.524, 0.488, all P<0.05), MOS was correlated with the above parameters.

MOS and sEMG based on Glazer protocol indicate that the contractility of pelvic floor muscle decreases in SUI patients. The results of sEMG and MOS are consistent, which can be used for quantitative evaluation of pelvic floor muscle function in SUI patients.

To explore the surgical opportunity of the transvaginal cervicoisthmic cerclage in the treatment of the cervical incompetence and the effect on the pregnancy outcomes.

A Retrospective controlled trial was carried out between January 2014 and December 2018 in the Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital in Zhejiang, China and a total of 1 027 patients with cervical incompetence underwent the transvaginal cerclage. According to the different surgical opportunity, the patients were divided into two groups: the conception cerclage (n=736) and the preconception cerclage (n=291), and the former were divided into two subgroups depending on the condition of the cervix, the history indicated conception cerclage (n=511) and the ultrasound indicated conception cerclage (n=225). Main outcome measures were the gestational age, term delivery rate, the fetal weight and the fetal survival rate.

After the cerclage, the gestational age was (36±4) weeks, the term delivery rate was 69.6% (710/1 020), the fetal weight was (3 038±624)g and the fetal survival rate was 94.7% (966/1 020). Compared with the ultrasound indicated conception cerclage subgroup, the gestational age, the term delivery rate, and the fetal weight were all significantly higher in the history indicated conception cerclage subgroup [(37±4) vs (36±5) weeks, t=2.691; 72.8% vs 62.7%,χ²=7.593; (3 091±594) vs (2 963±756) g, t=2.396; all P<0.05], but the fetal survival rate was comparable in these two groups(95.3% vs 92.9%, χ²=1.772, P>0.05). There were no significant differences in the gestational age, the term delivery rate, the fetal weight and fetal survival rate between the history indicated conception cerclage and the preconception cerclage (allP>0.05).

The transvaginal cervicoisthmic cerclage is a promising and safe technique for improving obstetric outcomes in women with cervical incompetence, and the history indicated conception cerclage is better than the ultrasound indicated cerclage.

To investigate the value of 3.0T MRI diffusion kurtosis imaging (DKI) quantitative histogram parameters in the differential diagnosis of rectal mucinous adenocarcinoma (MC) and common adenocarcinoma (AC).

One hundred and ten patients from Department of Radiology, the Second Affiliated Hospital of Soochow University between September 2015 and September 2019 with complete magnetic resonance imaging (MRI) and DKI results confirmed by surgery and pathology were retrospectively analyzed, including 16 patients in MC group and 94 patients in AC group. Two physicians outlined the region of interest (ROI) on the DKI image with b=1 000 s/mm², and obtained quantitative DKI parameters, including the diffusion coefficient (D value) and kurtosis coefficient (K value) corrected for non-Gaussian distribution. The apparent diffusion coefficient (ADC) values of quantitative parameters of diffusion-weighted imaging (DWI) were obtained through image registration, and histogram analysis was performed to obtain the mean value, 25th percentile, 50th percentile, 75th percentile, skewness and kurtosis of the above parameters, respectively. The difference between the quantitative histogram parameter analysis results of the rectal MC group and the AC group was evaluated, and the main indicators and multivariate comprehensive analysis indicators was screened, and the effectiveness of quantitative histogram parameters related to histopathological classification in the differential diagnosis of rectal MC and AC was evaluated.

There was no significant differences in gender, age, lesion location, T stage or N stage between MC group and AC group (all P>0.05). The multivariate binary logistic stepwise regression screening showed that D50th percentile and K25th percentile are statistically significant indicators (B values were 2 966.166 and -4.550, respectively; Wals values were 9.000 and 15.720, respectively; and P values were 0.003 and <0.001, respectively). The combined area under the curve of the two indictors was 0.85, but there was no statistically significant difference in pairwise comparison using DeLong method (P>0.05). The results of histogram analysis of quantitative parameters measured by the two physicians were consistent, and the inter-group correlation coefficient ranged from 0.880 to 0.981.

The quantitative parameter histogram analysis of the DKI double-index model is helpful for the differentiation of rectal MC and AC, in which the D50th percentile and K25th percentile have differential diagnosis significance, and are superior to the ADC value of the single-index model.

To explore the the effectiveness of using short-latency somatosensory evoked potential(SLSEP) combined with electroencephalogram(EEG) reactivity to predict the prognosis of severe brain injury(SBI) patients.

Consecutive patients with SBI admitted in neurosurgery intensive care unit(NSICU) at Xiangya Hospital of Central South University from July 2018 to January 2019 were prospectively collected. SLSEP and EEG were recorded in these patients in NSICU within two weeks after injury onset. EEG reactivity(EEG-R) was tested during EEG signal stabilization. In addition, the concentrations of serum neuron-specific enolase (NSE) and S100 protein were also detected. All patients were evaluated with Glasgow Outcome Scale(GOS) during 12 months′ follow-up. GOS grade 3 to 5 was defined as favorable group, and GOS grade 1 to 2 was defined as unfavorable group. The association of relevant predictors with patient′s prognosis was assessed. The area under the receiver operating characteristic (ROC) curve (AUC) was used to evaluate each potential predictor.

Forty-three patients were included in the study, with 26 patients of favorable outcomes and 17 patients with unfavorable prognosis. Univariate analysis revealed that the Glasgow Coma Scale (GCS) score, the concentration of serum NSE, EEG-R, the amplitude of SLSEP were all associated with the prognosis after 12 months′ follow-up. Moreover, the AUC for prediction of favorable prognosis by GCS, NSE, EEG-R, SLSEP was 0.661(95%CI: 0.493-0.829), 0.697(95%CI: 0.531-0.862), 0.718(95%CI: 0.557-0.879) and 0.758(95%CI: 0.609-0.907) respectively. However, there was no significant difference of age, gender, pupillary light reflex and S100 protein between the two groups. Furthermore, multiple logistic regression analysis showed that only SLSEP amplitude (OR=2.058, 95%CI: 0.867-4.888) and EEG-R(OR=3.748, 95%CI: 0.857-16.394) were independent predictors of favorable prognosis, and the prognostic model containing these two variables yielded an predictive performance with an AUC of 0.798.

The higher amplitude of SLSEP and the existence of EEG-R are predictors of good prognosis in SBI patients, and the combined use of SLSEP and EEG-R in predicting the prognosis of SBI patients is more reliable.

To investigate the cognitive impairment in patients with obstructive sleep apnea (OSA), and it's relationship with sleep-related respiratory indexes.

A total of 126 patients who were diagnosed with OSA and received treatment in the Sichuan Mental Health Center from March 2018 to September 2018 were selected as the OSA group, and 92 healthy volunteers with matched age, gender and education level were also recruited as the control group. All participants were assessed by polysomnography and the montreal cognitive assessment scale (MOCA).

(1) The total score of MOCA, visual space/executive function score, attention score, language function score and memory score in OSA group were significantly lower than those in the control group (23±4 vs 25±4, 2.0±1.7 vs 2.9±1.5, 5.4±1.0 vs 5.7±0.7, 2.7±0.6 vs 2.9±0.3, 2.6±1.4 vs 3.0±1.4, all P<0.05). The correlation analysis showed that MOCA score was in positive correlation with education level (r=0.585, P<0.001) and mean oxygen saturation (r=0.207, P=0.020). However, the MOCA score was in negative correlation with age (r=-0.564, P<0.001) and time in bed (TIB) (r=-0.205, P=0.021). There was no correlation between MOCA score and apnea-hypopnea index (AHI) (r=-0.006, P=0.949). Multiple linear regression analysis revealed that age (t=-4.133, P<0.001), education level (t=4.001, P<0.001) and mean oxygen saturation (t=2.036, P=0.044) were the major factors that contributed to the cognitive impairment of OSA patients.

Patients with OSA have cognitive impairment. The impairment gets more obvious when more severe hypoxia occurs at night, but it's not related to AHI.

To investigate the clinical features of patients with hypertrophic obstructive cardiomyopathy (HOCM) combined with obstructive sleep apnea (OSA).

From 2010 to 2018, a total of 299 patients who were diagnosed with hypertrophic cardiomyopathy and underwent sleep monitoring at Fuwai Hospital were retrospectively analyzed. General clinical features, data of echocardiography, and sleep breathing parameters were recorded. OSA was diagnosed by apnea-hypopnea index ≥ 5 events/hour. Clinical characteristics were compared between patients with and without OSA.

A total of 156 (52.2%) HOCM patients were diagnosed with OSA. Compared with patients without OSA, patients with OSA were older((54±10) years vs (45±14) years, P<0.001), had a higher body mass index ((27±3) kg/m² vs (25±3) kg/m², P<0.001), a higher prevalence of hypertension (54.4% (85/156) vs 21.0% (30/143),P<0.001), hyperlipidemia (37.2% (58/156) vs 13.3% (19/143),P<0.001) and smoking history (48.1% (75/156) vs 35.0% (50/143),P=0.022). Patients with OSA also had a higher incidence of New York Heart Association functional class Ⅱ or Ⅲ (P=0.017), atrial fibrillation (P=0.005), and higher levels of systolic and diastolic blood pressure, fast glucose and high-sensitive c-reactive protein (all P<0.001). Left ventricular end-diastolic diameter as well as ascending aorta diameter in patients with OSA were also greater than those without OSA (bothP<0.001). Apnea-hypopnea index (AHI) value positively correlated with left ventricular end-diastolic diameter (r=0.346), ascending aorta diameter (r=0.357) and high-sensitive c-reactive protein (r=0.230) (all P<0.001).

A high prevalence of OSA occurs in patients with HOCM. Severity of OSA correlates with cardiac remodeling and serum inflammatory factor level. As for HOCM patients, clinicians should actively monitor the sleep breathing parameters in order to recognize and treat potential OSA, thereby improving the prognosis of patients with HOCM.

To investigate the clinical efficacy of percutaneous vertebroplasty (PVP) combined with iodine-125 (¹²⁵I) seed brachytherapy in the treatment of spinal metastatic epidural spinal cord compression (MESCC) and toassess the changes inthe grade of epidural spinal cord compression (ESCC) by magnetic resonance imaging (MRI).

A total of 37 MESCC patients treated with PVP combined with ¹²⁵I seed brachytherapy in the interventional and vascular surgery department of Zhongda Hospital affiliated to Southeast University from January 2014 to June 2019 were retrospectively analyzed, including 23 cases of bilateral lower limbs paralysis. Total diseased vertebrae are 39 segments. Visual analogue scale (VAS) and paralysis of lower extremities were evaluated regularly before and after treatment, and VAS values at different follow-up time points were compared. At the same time, MRI was used to evaluate the changes of ESCC grade in the spinal canal and calculate the local lesion efficiency after operation. The postoperative local lesion efficiency at different follow-up times was compared.

PVP combined with ¹²⁵I seed implantation in all diseased vertebral bodies was successful. The average injection volume of polymethylmethacrylate (PMMA) was (3.2±1.3) ml/segment, the average number of ¹²⁵I seed implanted was (25.0±8.6) seeds/segment and the average radiation dose was (15.0±5.1) mCi/segment. The VAS before operation was 8.5, and postoperative VAS were respectively 3.6±1.3, 3.8±1.5, 3.4±1.4, 5.5±1.0, 5.9±1.4 at 5 days, 1 month, 3 months, 6 months, and 1 year after operation. The differences between all follow-up time points and preoperative VAS values were statistically significant (all P<0.001). Compared with 5 days, 1 month and 3 months after operation, VAS increased significantly at 6 months and 1 year after operation, and the difference was statistically significant (allP<0.001); there was no significant difference between the VAS value at 6 months after operation and 1 year after operation (P=0.405). At a follow-up of 3 months, 22 of 23 patients with paralysis of bilateral lower limbs regained the functions of autonomous walking and voiding; the effective rates of MESCC local lesions evaluated by MRI at 1 month, 3 months, 6 months, and>1 year were 89.7%, 91.9%, 90.6%, and 94.7%, respectively, and there was no statistically significant differences among those follow-up time points (allP>0.05).

PVP combined with ¹²⁵I seed brachytherapy in the treatment of MESCC has significant improvement in immediate pain relief and spinal cord function. After combined treatment, MRI showed that the tumors around the spinal cord regressed dramatically, which could considerably reduce the MESCC grade and remain stable for a long time.

To investigate the effects of patient-controlled intravenous analgesia with butorphanol versus sufentanil on early postoperative rehabilitation following radical laparoscopic nephrectomy.

One hundred patients undergoing radical laparoscopic nephrectomy in Affiliated Cancer Hospital of Zhengzhou University from September 2018 to February 2020 were divided into two groups (n=50) using a random number table: butorphanol patient-controlled intravenous analgesia group (group A) and sufentanil patient-controlled intravenous analgesia group (group B). Patient-controlled intravenous analgesia (PCIA) was performed at the end of surgery. The formulation of group A was butorphanol (0.15 mg/kg) and ketorolac tromethamine (180 mg) using the physiological saline at a dilution of 100 ml. The formulation of group B was sufentanil (1.5 μg/kg) and ketorolac tromethamine (180 mg) using the physiological saline at a dilution of 100 ml. At the time points of 4, 8, 24, 48 h after operation (T ₁, T₂, T₃, T₄), VAS scores at rest and cough were recorded. The incidence of remedial analgesia, the number of pressings during 48 h after the operation, the postoperative anal exhaust recovery time of the patients were recorded. Quality of recovery-40(QoR-40) scores were recorded at T₃ and T₄. Adverse reactions were recorded.

There was no significant difference in VAS scores at rest and cough at T₁, T₂, T₃ and T₄ between two groups (all P>0.05). There was no significant difference in the incidence of remedial analgesia and the number of pressings during 48 h after the operation between two groups (allP>0.05). The postoperative anal exhaust recovery time of the patients in group A was (32±6) h, which was lower than that in group B with statistically significant difference [(40±5) h,t=7.937, P<0.01]. The QoR-40 total scores in group A were higher than those in group B at T₃ and T₄, which were (185.8±2.5) vs (170.7±2.7), (194.8±1.9) vs (183.6±2.6), and the differences were statistically significant (t=28.878, 25.025, all P<0.01). The incidence of nausea, retching/vomiting, respiratory depression and itch during 48 h after the operation in group A were 10%, 6%, 2%, 2%, which were lower than that in group B (32%, 20%, 14%, 18%), with statistically significant difference (χ²=7.294, 4.322, 4.891, 5.983, all P<0.05).

PCIA with butorphanol or sufentanil can provide satisfactory analgesia for patients undergoing radical laparoscopic nephrectomy, but butorphanol can promote postoperative rehabilitation with fewer adverse reactions.

The Accelerated Rehabilitation Surgery (ERAS) pathway reduces hospital stay length and expense and improves patient satisfaction. However, prospective studies on accelerated rehabilitation after spinal surgery are rare. In this paper, the ERAS approach to improve the quality of rehabilitation after single and double-level lumbar fusion was studied and analyzed. Patients received accelerated rehabilitation (17 preoperative, intraoperative, and postoperative treatment measures based on evidence-based medical evidence) or conventional treatment through a double-blind patient and evaluator randomized study of 56 patients. The quality of rehabilitation-40 score (40-200 points) on the 3rd postoperative day was taken as the main outcome measure. A difference in scores>12 points was defined as having a clinically significant difference. Secondary outcome measures included quality of rehabilitation-40 score on postoperative days 0-2, 14 and 56; Recovery diet time and physical therapy end time; Day of hospitalization; Pain score (0 to 10); Opioid consumption (morphine equivalent); Patient-controlled duration of intravenous analgesic drug use; Markers of complications and surgical stress (interleukin-6, cortisol and C-reactive protein). The study included 25 ERAS-treated patients and 26 routine-treated patients. On postoperative day 3, the quality of rehabilitation-40 score was significantly higher in the ERAS treatment group than in the conventional treatment group [(179 ± 14) versus (170 ± 16) points,P=0.041]。 There was no statistically significant difference between the two groups at postoperative days 0, 1, 2, 14 and 56. The comfort dimension score of the quality of rehabilitation-40 score was higher in the ERAS treatment group (P=0.008), time to return to diet and patient-controlled intravenous analgesic use were shorter (bothP<0.05）； Opioid use was lower on postoperative day 1 and did not reversely affect pain scores; C-reactive protein was lower on postoperative day 3. The results of the study confirm that the ERAS pathway can enable patients to obtain significant benefits in the early stage of recovery. However, significant clinical effects have not been confirmed in this study.

The medical and economic implications of the treatment of intertrochanteric fractures of the femur are increasingly evident. This study looked at the effect of treatment of intertrochanteric fractures of the femur under the concept of Accelerated Rehabilitation Surgery (ERAS) without compromising the quality of treatment on the length of hospital stay. A prospective, observational, single-center cohort study was conducted to compare the differences between the ERAS-treated group and the control group in cases of proximal femoral fractures of AO type A1 or A2 who underwent intramedullary nailing surgery and were treated with post-acute phase rehabilitation (PAR) at Angers Teaching Hospital, France, from 2014 to 2016. The ERAS-treated group entered the PAR pathway on the postoperative day. Patients in the control group underwent routine postoperative management in the surgical room before entering the PAR pathway. The main outcome measure of this study was total length of stay, including preoperative and PAR treatment stay. Secondary outcome measures were immediate patient survival, 1-year postoperative survival, postoperative complications, and mean hospitalization costs. After screening, 54 paired patients (27 pairs) were selected for inclusion in the study from 109 patients initially enrolled. Patients in the ERAS-treated group had (45.85 ± 19.24) d and (48.56 ± 19.36) d of PAR treatment and total hospital stay, respectively (n=27), and the PAR treatment and total hospital stay in the control group were (68.41 ± 48.77) d and (77.85 ± 48.80) d, respectively (n=27）。 Patients in the ERAS treatment group significantly decreased the length of stay and total length of stay for PAR treatment (bothP<0.05）。 There were no statistically significant differences in the number of early deaths, complication rates, and 1-year survival without rehospitalization between the two groups. The average hospitalization cost of patients in the ERAS treatment group was lower. The ERAS therapeutic pathway has been implemented in orthopedics. For patients with hip fractures, the ERAS pathway can reduce the total length of hospital stay in patients with intertrochanteric fractures without increasing mortality and complication rates. The 1-year postoperative survival rates were comparable in both groups. At the same time, this process does not negatively affect the quality of treatment.