A nursing-driven enhanced recovery after surgery protocol improves postoperative outcomes in hip surgery: a prospective cohort study.

BACKGROUND

Enhanced recovery after surgery (ERAS) programs improve outcomes after major orthopedic procedures, but the specific contribution of nursing-led implementation has not been well defined. This study evaluated the impact of a nursing-driven ERAS protocol on recovery outcomes in patients undergoing hip surgery.

METHODS

A prospective cohort study was conducted in a tertiary academic center. Patients managed under a structured nursing-coordinated ERAS pathway (N.=36) were compared with historical controls receiving conventional perioperative care (N.=34). The cohort included total hip arthroplasty, hemiarthroplasty, and internal fixation procedures. The ERAS protocol emphasized nurse-led preoperative education, multimodal analgesia, early mobilization, nutritional optimization, and standardized postoperative monitoring. Primary outcomes were hospital length of stay (LOS) and postoperative complications. Secondary outcomes included pain scores, opioid consumption, early functional recovery, discharge disposition, and patient satisfaction.

RESULTS

Baseline characteristics and distribution of surgical procedures were comparable between groups. The ERAS cohort experienced a significantly shorter LOS (median 7 vs. 9 days; P<0.01) and fewer postoperative complications, with the control group exhibiting approximately triple the complication rate. ERAS patients reported lower pain scores and nearly 50% less opioid use postoperatively. Early mobilization within 24 hours was achieved in 89% of ERAS patients versus 50% of controls (P<0.01). More ERAS patients were discharged directly home, and satisfaction scores were higher (94% vs. 76%; P=0.04).

CONCLUSIONS

A nursing-driven ERAS protocol significantly enhanced postoperative recovery across a heterogeneous hip surgery population. Nurse-led coordination and adherence monitoring were central to improved outcomes. These findings support broader adoption of nursing-centered ERAS pathways to optimize surgical recovery.