Geriatric hip fracture and enhanced recovery after surgery: current status and future perspectives_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XIE Tian ^1,2,3,4,5 , TIAN Chuwei ^3,4,5 ,  RUI Yunfeng ^1,2,3,4,5

1. Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P. R. China;
2. Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P. R. China;
3. Orthopaedic Trauma Institute, Southeast University, Nanjing Jiangsu, 210009, P. R. China;
4. Multidisciplinary Team (MDT) for Geriatric Hip Fracture Comprehensive Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P. R. China;
5. School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P. R. China;

Corresponding?author：

RUI Yunfeng, Email: ruiyunfeng@126.com

Keywords：

Aging; hip fracture; enhanced recovery after surgery; treatment management

DOI：

10.7507/1002-1892.202511076

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

In recent years, considerable progress has been made in the specific development and practice of enhanced recovery after surgery (ERAS) for geriatric hip fracture domestically and internationally. By synthesizing domestic and international research reports, this article analyzes the current status of key development areas of ERAS for geriatric hip fracture and puts forward future prospects. The main contents include the crises and opportunities of geriatric hip fracture against the backdrop of deep aging, the specific implementation of team and model construction in the application of ERAS concept to geriatric hip fracture management, the benefits and effect evaluation of recent studies, as well as the opportunities and innovative pathways brought by the development of big data and artificial intelligence for the future development of ERAS in this field.

Citation： XIE Tian, TIAN Chuwei, RUI Yunfeng. Geriatric hip fracture and enhanced recovery after surgery: current status and future perspectives. Chinese Journal of Reparative and Reconstructive Surgery, 2026, 40(1): 69-74. doi: 10.7507/1002-1892.202511076 Copy

1.	Bhandari M, Swiontkowski M. Management of acute hip fracture. N Engl J Med, 2017, 377(21): 2053-2062.
2.	謝添, 馬彬彬, 李滎娟, 等. 加速康復外科在老年髖部骨折的研究現狀. 中國修復重建外科雜志, 2018, 32(08): 1038-1046.
3.	呂振邦, 李庭, 吳新寶. 加速康復外科理念下老年髖部骨折圍手術期管理的研究進展. 中華創傷骨科雜志, 2018, 20(5): 451-455.
4.	Brauer CA, Coca-Perraillon M, Cutler DM, et al. Incidence and mortality of hip fractures in the United States. JAMA, 2009, 302(14): 1573-1579.
5.	Tian C, Shi L, Wang J, et al. Global, regional, and national burdens of hip fractures in elderly individuals from 1990 to 2021 and predictions up to 2050: A systematic analysis of the Global Burden of Disease Study 2021. Arch Gerontol Geriatr, 2025, 133: 105832. doi: 10.1016/j.archger.2025.105832.
6.	田楚偉, 謝添, 石柳, 等. 中國老年髖部骨折報告2025 [J/OL]. 重慶醫科大學學報, (2025-10-29) [2025-12-12]. https://doi.org/10.13406/j.cnki.cyxb.003975.
7.	Jin F, Chung F. Minimizing perioperative adverse events in the elderly. Br J Anaesth, 2001, 87(4): 608-624.
8.	Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth, 1997, 78(5): 606-617.
9.	周洋洋, 芮云峰, 魯攀攀, 等. 多學科協作診療模式在老年髖部骨折臨床應用中的研究進展. 中國修復重建外科雜志, 2020, 34(1): 132-138.
10.	Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg, 2017, 152(3): 292-298.
11.	姜耀, 賈云洋, 霍妍, 等. 加速康復外科理念下骨科圍手術期健康教育方案優化的專家共識. 骨科臨床與研究雜志, 2024, 9(4): 197-202.
12.	白求恩·骨科加速康復聯盟, 白求恩公益基金會創傷骨科專業委員會, 白求恩公益基金會關節外科專業委員會, 等. 骨科手術圍手術期禁食禁飲管理指南. 中華創傷骨科雜志, 2019, 21(10): 829-834.
13.	鄧春花, 陳小華, 尹芝華, 等. 老年髖部骨折患者圍術期營養護理管理專家共識(2023版). 中華創傷雜志, 2023, 39(5): 394-403.
14.	中國康復技術轉化及發展促進會, 中華醫學會麻醉學分會, 中國醫師協會麻醉學醫師分會, 等. 骨科、麻醉科加速康復圍手術期患者血液管理專家共識(2025年版). 中華骨科雜志, 2025, 45(7): 393-401.
15.	中華人民共和國國家衛生健康委員會醫政司. 老年髖部骨折診療與管理指南(2022年版). 骨科臨床與研究雜志, 2023, 8(2): 77-83.
16.	Brox WT, Roberts KC, Taksali S, et al. The American Academy of Orthopaedic Surgeons Evidence-Based Guideline on Management of Hip Fractures in the Elderly. J Bone Joint Surg (Am), 2015, 97(14): 1196-1199.
17.	Roberts KC, Brox WT. AAOS Clinical Practice Guideline: Management of Hip Fractures in the Elderly. J Am Acad Orthop Surg, 2015, 23(2): 138-140.
18.	莢衛東. 加速康復外科多學科團隊建設. 中華外科雜志, 2018, 56(1): 14-17.
19.	Zhang Q, Chen Y, Li Y, et al. Enhanced recovery after surgery in patients after hip and knee arthroplasty: a systematic review and meta-analysis. Postgrad Med J, 2024, 100(1181): 159-173.
20.	Scott NB, McDonald D, Campbell J, et al. The use of enhanced recovery after surgery (ERAS) principles in Scottish orthopaedic units—an implementation and follow-up at 1 year, 2010-2011: a report from the Musculoskeletal Audit, Scotland. Arch Orthop Trauma Surg, 2013, 133(1): 117-124.
21.	Bogani G, Sarpietro G, Ferrandina G, et al. Enhanced recovery after surgery (ERAS) in gynecology oncology. Eur J Surg Oncol, 2021, 47(5): 952-959.
22.	Greco M, Capretti G, Beretta L, et al. Enhanced recovery program in colorectal surgery: a meta-analysis of randomized controlled trials. World J Surg, 2014, 38(6): 1531-1541.
23.	Kennie DC, Reid J, Richardson IR, et al. Effectiveness of geriatric rehabilitative care after fractures of the proximal femur in elderly women: a randomised clinical trial. BMJ, 1988, 297(6656): 1083-1086.
24.	Gilchrist WJ, Newman RJ, Hamblen DL, et al. Prospective randomised study of an orthopaedic geriatric inpatient service. BMJ, 1988, 297(6656): 1116-1118.
25.	Shigemoto K, Sawaguchi T, Horii T, et al. Multidisciplinary care model for geriatric patients with hip fracture in Japan: 5-year experience. Arch Orthop Trauma Surg, 2022, 142(9): 2205-2214.
26.	吳新寶, 楊明輝, 張萍, 等. 老年病科和骨科共管模式縮短老年髖部骨折患者術前等待時間和住院時間. 骨科臨床與研究雜志, 2017, 2(2): 96-100.
27.	楊明輝, 吳新寶, 龔曉峰, 等. 骨科與老年科共管模式治療老年髖部骨折及與英國的比較. 中國骨與關節雜志, 2017, 6(3): 169-173.
28.	Gupta A. The effectiveness of geriatrician-led comprehensive hip fracture collaborative care in a new acute hip unit based in a general hospital setting in the UK. J R Coll Physicians Edinb, 2014, 44(1): 20-26.
29.	李庭, 周雁, 孫旭, 等. 縮短創傷骨科擇期手術患者圍手術期禁食水時間的前瞻性隊列研究. 中華創傷骨科雜志, 2018, 20(4): 312-317.
30.	李庭, 米萌. 加速康復外科在創傷骨科應用的幾個問題. 中華醫學雜志, 2020, 100(37): 2881-2884.
31.	芮云峰, 邱曉東, 鄒繼紅, 等. 多學科協作診療模式在老年髖部骨折的臨床應用. 中國修復重建外科雜志, 2019, 33(10): 1276-1282.
32.	Gao Y, Zhou S, Gao W, et al. Preoperative indicators for 1-year mortality in elderly individuals following hip fracture surgery under a multidisciplinary team co-management model: a single-centre retrospective observational study. Geriatr Orthop Surg Rehabil, 2025, 16: 21514593251356135. doi: 10.1177/21514593251356135.
33.	Zhou J, Shi L, Tian C, et al. Effects of an emergency-based fase strategy on treating geriatric patients with femoral neck fracture: a retrospective propensity score-matched study. Clin Interv Aging, 2024, 19: 1867-1880.
34.	中國脆性骨折聯盟, 中國老年醫學學會骨與關節分會創傷骨科學術工作委員會, 白求恩·骨科加速康復聯盟, 等. 老年股骨轉子間骨折診療指南. 中華創傷骨科雜志, 2020, 22(2): 93-99.
35.	中國老年醫學學會骨與關節分會創傷骨科學術工作委員會. 老年髖部骨折診療專家共識 (2017). 中華創傷骨科雜志, 2017, 19(11): 921-927.
36.	Liu VX, Rosas E, Hwang J, et al. Enhanced recovery after surgery program implementation in 2 surgical populations in an integrated health care delivery system. JAMA Surg, 2017, 152(7): e171032. doi: 10.1001/jamasurg.2017.1032.
37.	Memtsoudis SG, Poeran J, Kehlet H. Enhanced recovery after surgery in the United States: From evidence-based practice to uncertain science? JAMA, 2019, 321(11): 1049-1050.
38.	Orosz GM, Magaziner J, Hannan EL, et al. Association of timing of surgery for hip fracture and patient outcomes. JAMA, 2004, 291(14): 1738-1743.
39.	Khan SK, Kalra S, Khanna A, et al. Timing of surgery for hip fractures: a systematic review of 52 published studies involving 291, 413 patients. Injury, 2009, 40(7): 692-697.
40.	Tian C, Zhu H, Shi L, et al. Is there a “black friday” for geriatric hip fracture surgery? Orthop Surg, 2023, 15(5): 1304-1311.
41.	Middleton M, Wan B, da Assun?ao R. Improving hip fracture outcomes with integrated orthogeriatric care: a comparison between two accepted orthogeriatric models. Age Ageing, 2017, 46(3): 465-470.
42.	Kristensen PK, Thillemann TM, S?balle K, et al. Can improved quality of care explain the success of orthogeriatric units? A population-based cohort study. Age Ageing, 2016, 45(1): 66-71.
43.	Bell JJ, Bauer JD, Capra S, et al. Multidisciplinary, multi-modal nutritional care in acute hip fracture inpatients-results of a pragmatic intervention. Clin Nutr, 2014, 33(6): 1101-1107.
44.	Rotman-Pikielny P, Frankel M, Lebanon OT, et al. Orthopedic-Metabolic Collaborative Management for Osteoporotic Hip Fracture. Endocr Pract, 2018, 24(8): 718-725.
45.	Kristensen PK, R?ck ND, Christensen HC, et al. The danish multidisciplinary hip fracture registry 13-year results from a population-based cohort of hip fracture patients. Clin Epidemiol, 2020, 12: 9-21.
46.	黃澤宇, 徐宏偉, 朱建棟, 等. 市縣醫院骨科、麻醉科加速康復實施管理專家共識. 中華骨與關節外科雜志, 2025, 18(3): 200-211.
47.	Zhang YW, Lu PP, Li YJ, et al. Short report: relationship between self-reported sleep characteristics and falls-associated fractures in elderly individuals: a population-based study. Psychol Health Med, 2023, 28(4): 946-954.
48.	Qi YM, Li YJ, Zou JH, et al. Risk factors for postoperative delirium in geriatric patients with hip fracture: A systematic review and meta-analysis. Front Aging Neurosci, 2022, 14: 960364. doi: 10.3389/fnagi.2022.960364.
49.	田楚偉, 陳翔溆, 朱桓毅, 等. 機器學習在創傷骨科中的應用與展望. 中國修復重建外科雜志, 2023, 37(12): 1562-1568.
50.	Tian CW, Gao YC, Rui C, et al. Artificial intelligence in orthopaedic trauma. EngMedicine, 2024, 1(2): 100020. doi: 10.1016/j.engmed.2024.100020.
51.	吳新寶, 孫志堅. 加速康復外科在創傷骨科的推廣及展望. 骨科臨床與研究雜志, 2022, 7(1): 1-3.

1. Bhandari M, Swiontkowski M. Management of acute hip fracture. N Engl J Med, 2017, 377(21): 2053-2062.
2. 謝添, 馬彬彬, 李滎娟, 等. 加速康復外科在老年髖部骨折的研究現狀. 中國修復重建外科雜志, 2018, 32(08): 1038-1046.
3. 呂振邦, 李庭, 吳新寶. 加速康復外科理念下老年髖部骨折圍手術期管理的研究進展. 中華創傷骨科雜志, 2018, 20(5): 451-455.
4. Brauer CA, Coca-Perraillon M, Cutler DM, et al. Incidence and mortality of hip fractures in the United States. JAMA, 2009, 302(14): 1573-1579.
5. Tian C, Shi L, Wang J, et al. Global, regional, and national burdens of hip fractures in elderly individuals from 1990 to 2021 and predictions up to 2050: A systematic analysis of the Global Burden of Disease Study 2021. Arch Gerontol Geriatr, 2025, 133: 105832. doi: 10.1016/j.archger.2025.105832.
6. 田楚偉, 謝添, 石柳, 等. 中國老年髖部骨折報告2025 [J/OL]. 重慶醫科大學學報, (2025-10-29) [2025-12-12]. https://doi.org/10.13406/j.cnki.cyxb.003975.
7. Jin F, Chung F. Minimizing perioperative adverse events in the elderly. Br J Anaesth, 2001, 87(4): 608-624.
8. Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth, 1997, 78(5): 606-617.
9. 周洋洋, 芮云峰, 魯攀攀, 等. 多學科協作診療模式在老年髖部骨折臨床應用中的研究進展. 中國修復重建外科雜志, 2020, 34(1): 132-138.
10. Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg, 2017, 152(3): 292-298.
11. 姜耀, 賈云洋, 霍妍, 等. 加速康復外科理念下骨科圍手術期健康教育方案優化的專家共識. 骨科臨床與研究雜志, 2024, 9(4): 197-202.
12. 白求恩·骨科加速康復聯盟, 白求恩公益基金會創傷骨科專業委員會, 白求恩公益基金會關節外科專業委員會, 等. 骨科手術圍手術期禁食禁飲管理指南. 中華創傷骨科雜志, 2019, 21(10): 829-834.
13. 鄧春花, 陳小華, 尹芝華, 等. 老年髖部骨折患者圍術期營養護理管理專家共識(2023版). 中華創傷雜志, 2023, 39(5): 394-403.
14. 中國康復技術轉化及發展促進會, 中華醫學會麻醉學分會, 中國醫師協會麻醉學醫師分會, 等. 骨科、麻醉科加速康復圍手術期患者血液管理專家共識(2025年版). 中華骨科雜志, 2025, 45(7): 393-401.
15. 中華人民共和國國家衛生健康委員會醫政司. 老年髖部骨折診療與管理指南(2022年版). 骨科臨床與研究雜志, 2023, 8(2): 77-83.
16. Brox WT, Roberts KC, Taksali S, et al. The American Academy of Orthopaedic Surgeons Evidence-Based Guideline on Management of Hip Fractures in the Elderly. J Bone Joint Surg (Am), 2015, 97(14): 1196-1199.
17. Roberts KC, Brox WT. AAOS Clinical Practice Guideline: Management of Hip Fractures in the Elderly. J Am Acad Orthop Surg, 2015, 23(2): 138-140.
18. 莢衛東. 加速康復外科多學科團隊建設. 中華外科雜志, 2018, 56(1): 14-17.
19. Zhang Q, Chen Y, Li Y, et al. Enhanced recovery after surgery in patients after hip and knee arthroplasty: a systematic review and meta-analysis. Postgrad Med J, 2024, 100(1181): 159-173.
20. Scott NB, McDonald D, Campbell J, et al. The use of enhanced recovery after surgery (ERAS) principles in Scottish orthopaedic units—an implementation and follow-up at 1 year, 2010-2011: a report from the Musculoskeletal Audit, Scotland. Arch Orthop Trauma Surg, 2013, 133(1): 117-124.
21. Bogani G, Sarpietro G, Ferrandina G, et al. Enhanced recovery after surgery (ERAS) in gynecology oncology. Eur J Surg Oncol, 2021, 47(5): 952-959.
22. Greco M, Capretti G, Beretta L, et al. Enhanced recovery program in colorectal surgery: a meta-analysis of randomized controlled trials. World J Surg, 2014, 38(6): 1531-1541.
23. Kennie DC, Reid J, Richardson IR, et al. Effectiveness of geriatric rehabilitative care after fractures of the proximal femur in elderly women: a randomised clinical trial. BMJ, 1988, 297(6656): 1083-1086.
24. Gilchrist WJ, Newman RJ, Hamblen DL, et al. Prospective randomised study of an orthopaedic geriatric inpatient service. BMJ, 1988, 297(6656): 1116-1118.
25. Shigemoto K, Sawaguchi T, Horii T, et al. Multidisciplinary care model for geriatric patients with hip fracture in Japan: 5-year experience. Arch Orthop Trauma Surg, 2022, 142(9): 2205-2214.
26. 吳新寶, 楊明輝, 張萍, 等. 老年病科和骨科共管模式縮短老年髖部骨折患者術前等待時間和住院時間. 骨科臨床與研究雜志, 2017, 2(2): 96-100.
27. 楊明輝, 吳新寶, 龔曉峰, 等. 骨科與老年科共管模式治療老年髖部骨折及與英國的比較. 中國骨與關節雜志, 2017, 6(3): 169-173.
28. Gupta A. The effectiveness of geriatrician-led comprehensive hip fracture collaborative care in a new acute hip unit based in a general hospital setting in the UK. J R Coll Physicians Edinb, 2014, 44(1): 20-26.
29. 李庭, 周雁, 孫旭, 等. 縮短創傷骨科擇期手術患者圍手術期禁食水時間的前瞻性隊列研究. 中華創傷骨科雜志, 2018, 20(4): 312-317.
30. 李庭, 米萌. 加速康復外科在創傷骨科應用的幾個問題. 中華醫學雜志, 2020, 100(37): 2881-2884.
31. 芮云峰, 邱曉東, 鄒繼紅, 等. 多學科協作診療模式在老年髖部骨折的臨床應用. 中國修復重建外科雜志, 2019, 33(10): 1276-1282.
32. Gao Y, Zhou S, Gao W, et al. Preoperative indicators for 1-year mortality in elderly individuals following hip fracture surgery under a multidisciplinary team co-management model: a single-centre retrospective observational study. Geriatr Orthop Surg Rehabil, 2025, 16: 21514593251356135. doi: 10.1177/21514593251356135.
33. Zhou J, Shi L, Tian C, et al. Effects of an emergency-based fase strategy on treating geriatric patients with femoral neck fracture: a retrospective propensity score-matched study. Clin Interv Aging, 2024, 19: 1867-1880.
34. 中國脆性骨折聯盟, 中國老年醫學學會骨與關節分會創傷骨科學術工作委員會, 白求恩·骨科加速康復聯盟, 等. 老年股骨轉子間骨折診療指南. 中華創傷骨科雜志, 2020, 22(2): 93-99.
35. 中國老年醫學學會骨與關節分會創傷骨科學術工作委員會. 老年髖部骨折診療專家共識 (2017). 中華創傷骨科雜志, 2017, 19(11): 921-927.
36. Liu VX, Rosas E, Hwang J, et al. Enhanced recovery after surgery program implementation in 2 surgical populations in an integrated health care delivery system. JAMA Surg, 2017, 152(7): e171032. doi: 10.1001/jamasurg.2017.1032.
37. Memtsoudis SG, Poeran J, Kehlet H. Enhanced recovery after surgery in the United States: From evidence-based practice to uncertain science? JAMA, 2019, 321(11): 1049-1050.
38. Orosz GM, Magaziner J, Hannan EL, et al. Association of timing of surgery for hip fracture and patient outcomes. JAMA, 2004, 291(14): 1738-1743.
39. Khan SK, Kalra S, Khanna A, et al. Timing of surgery for hip fractures: a systematic review of 52 published studies involving 291, 413 patients. Injury, 2009, 40(7): 692-697.
40. Tian C, Zhu H, Shi L, et al. Is there a “black friday” for geriatric hip fracture surgery? Orthop Surg, 2023, 15(5): 1304-1311.
41. Middleton M, Wan B, da Assun?ao R. Improving hip fracture outcomes with integrated orthogeriatric care: a comparison between two accepted orthogeriatric models. Age Ageing, 2017, 46(3): 465-470.
42. Kristensen PK, Thillemann TM, S?balle K, et al. Can improved quality of care explain the success of orthogeriatric units? A population-based cohort study. Age Ageing, 2016, 45(1): 66-71.
43. Bell JJ, Bauer JD, Capra S, et al. Multidisciplinary, multi-modal nutritional care in acute hip fracture inpatients-results of a pragmatic intervention. Clin Nutr, 2014, 33(6): 1101-1107.
44. Rotman-Pikielny P, Frankel M, Lebanon OT, et al. Orthopedic-Metabolic Collaborative Management for Osteoporotic Hip Fracture. Endocr Pract, 2018, 24(8): 718-725.
45. Kristensen PK, R?ck ND, Christensen HC, et al. The danish multidisciplinary hip fracture registry 13-year results from a population-based cohort of hip fracture patients. Clin Epidemiol, 2020, 12: 9-21.
46. 黃澤宇, 徐宏偉, 朱建棟, 等. 市縣醫院骨科、麻醉科加速康復實施管理專家共識. 中華骨與關節外科雜志, 2025, 18(3): 200-211.
47. Zhang YW, Lu PP, Li YJ, et al. Short report: relationship between self-reported sleep characteristics and falls-associated fractures in elderly individuals: a population-based study. Psychol Health Med, 2023, 28(4): 946-954.
48. Qi YM, Li YJ, Zou JH, et al. Risk factors for postoperative delirium in geriatric patients with hip fracture: A systematic review and meta-analysis. Front Aging Neurosci, 2022, 14: 960364. doi: 10.3389/fnagi.2022.960364.
49. 田楚偉, 陳翔溆, 朱桓毅, 等. 機器學習在創傷骨科中的應用與展望. 中國修復重建外科雜志, 2023, 37(12): 1562-1568.
50. Tian CW, Gao YC, Rui C, et al. Artificial intelligence in orthopaedic trauma. EngMedicine, 2024, 1(2): 100020. doi: 10.1016/j.engmed.2024.100020.
51. 吳新寶, 孫志堅. 加速康復外科在創傷骨科的推廣及展望. 骨科臨床與研究雜志, 2022, 7(1): 1-3.

Chinese Journal of Reparative and Reconstructive Surgery

Geriatric hip fracture and enhanced recovery after surgery: current status and future perspectives

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content