Application Of Enhanced Recovery After Surgery In Perioperative Nursing Care Of Elderly Patients With Total Hip Arthroplasty

Objectives:This study aims to explore the effect of perioperative nursing care of Enhanced Recovery After Surgery(ERAS)in the rehabilitation of elderly patients undergoing primary unilateral total hip arthroplasty(THA).Methods:An experimental study was conducted with a purposive sampling of 96 primary unilateral THA patients recruited from the orthopedic ward of the First Affiliated Hospital of Xi'an Jiaotong University.The patients were divided into two groups with each group including 48 of them.The patients in the intervention group received ERAS,and which includes pain management,healthy education,nutrition management,normothermia maintaining,preoperative and postoperative functional exercises.The patients in the control group received conventional nursing care.A self-developed general information questionnaire and the Harris Hip Score Scale were used to collect data,including the time of the first time of passing gas and off-bed after surgery,the length of hospital stays,hospitalization cost,the probability of occurrence of early postoperative complications and the Harris score of the research objects on the 3rd and7th day after surgery.All of the data was entered into Epidata 3.1 to establish a database and analyzed by SPSS 22.0.The statistical description methods included frequency,percentage,mean and standard deviation.The statistical analysis methods included independent samples t test,Chi-square test,Fisher exact probability method and non-parametric test.Results:A total of 92 eligible patients with THA completed the study with 47 of them in the intervention group and 45 in the control group.There was no statistically significant difference between the two groups in terms of the general information(P>0.05).The baseline data of the two groups are balanced and comparable.The time needed for passing gas for the first time after operation in the intervention group was(6.27±2.83)h,shorter than that of the control group(8.91±5.34)h,and the difference was statistically significant(Z=-2.18,P<0.05);The time needed for off-bed for the first time after operation was(1.49±0.29)d,shorter than that of the control group(4.07±0.31)d,and the difference was statistically significant(t=-2.73,P<0.05);The length of hospital stays of the patients in the intervention group was(7.51±1.98)d,shorter than that of the control group(10.92±4.58)d,and the difference between the two groups was statistically significant(t=-1.99,P<0.05);The average hospitalization cost of the patients in the intervention group was(55,739.71±4077.60)Yuan,and that of the patients in the control group was(63,284.78±6518.92)Yuan.,there was no significant difference between the two groups(t=-0.37,P>0.05);The total occurrence of early postoperative complications in the intervention group(12.77%)was lower than that in the control group(37.78%),and the difference was statistically significant(?~2=7.67,P<0.01).Among them,the incidence of nausea and vomiting in the intervention group(4.26%)was lower than that in the control group(20.00%),and the difference was statistically significant(?~2=5.41,P<0.05).The average Harris score of the patients in the intervention group was(52.95±17.48)on the 3rd day after operation,higher than that of the control group(41.84±17.53),there was no statistically significant difference between the two groups(t=0.28,P>0.05),but there was statistically significant difference in pain dimension(t=3.18,P<0.01).The average score of the intervention group was(80.37±12.13)on the 7th day after operation,higher than that of the control group(65.51±10.74),and the difference was statistically significant(Z=2.11,P<0.05),and there was statistically significant difference in function(Z=2.28,P<0.05)and activity(Z=-2.32,P<0.05);The rate of the excellent and good grades of the intervention group(72.34%)was higher than that of the control group(11.11%)on the 7th day after operation,the distribution of the score grades of the two groups was different and the difference was statistically significant(Z=-6.65,P<0.001).Conclusions:The perioperative nursing care of ERAS have effectively accelerated the rehabilitation of elderly patients with primary unilateral THA.It is effective in reducing the time of passing gas and off-bed for the first time,cutting the length of hospital stays,reducing the occurrence of early postoperative complications and promoting the recovery of hip function;However,the hospitalization cost wasn't reduced.