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Background <p>This study aims to investigate the effect of a multidisciplinary perioperative management strategy based on the enhanced recovery after surgery (ERAS) concept (including anesthesia regimen optimization, goal-directed fluid therapy, multimodal analgesia, and post-anesthesia care unit (PACU) refined nursing) on the incidence and severity of emergence agitation (EA) in elderly patients undergoing hip fracture surgery under general anesthesia.</p> Methods <p>Clinical data from 120 elderly patients who underwent hip fracture surgery between April 1, 2023, and June 30, 2025, were retrospectively analyzed. Patients admitted between April 1, 2023, and September 30, 2023, who received conventional post-anesthesia care were assigned to the conventional group. Patients admitted between October 1, 2023, and June 30, 2025, who received perioperative management based on the ERAS concept were assigned to the ERAS group. The primary outcome measure, the incidence of emergence agitation (EA) within 60&#xa0;min after extubation, was assessed using the Riker Sedation-Agitation Scale (Riker-SAS). Pain intensity within 60&#xa0;min post-extubation was evaluated using the Visual Analog Scale (VAS). Secondary outcome measures within 60&#xa0;min post-extubation were recorded for both groups, including the occurrence of adverse events (hypertension, tachycardia, unplanned extubation), the incidence of hypothermia, emergence time, extubation time, length of PACU stay, time to first ambulation after surgery, total hospital length of stay, and the incidence of postoperative complications. Differences between the two groups were compared in terms of both primary and secondary outcome measures.</p> Results <p>Compared to the conventional group, the observation group demonstrated significantly lower Riker Sedation-Agitation Scale (Riker-SAS) scores, Visual Analog Scale (VAS) pain scores, incidence of emergence hypothermia, emergence time, extubation time, duration of stay in the post-anesthesia care unit (PACU), time to first postoperative ambulation, and total hospital length of stay (<i>P</i> &lt; 0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (<i>P</i> &gt; 0.05).</p> Conclusions <p>A perioperative management strategy based on the ERAS concept may be associated with a reduced incidence of emergence agitation in elderly patients undergoing hip fracture surgery under general anesthesia.</p> Graphical Abstract <p></p>

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Effect of perioperative management based on enhanced recovery after surgery (ERAS) principles on emergence agitation in elderly patients undergoing hip fracture surgery under general anesthesia

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  • 发表日期：

    2026年7月21日

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  • Ting Shen,
  • Jianying He,
  • Daowu Guo,
  • Yang Xu

摘要

Background

This study aims to investigate the effect of a multidisciplinary perioperative management strategy based on the enhanced recovery after surgery (ERAS) concept (including anesthesia regimen optimization, goal-directed fluid therapy, multimodal analgesia, and post-anesthesia care unit (PACU) refined nursing) on the incidence and severity of emergence agitation (EA) in elderly patients undergoing hip fracture surgery under general anesthesia.

Methods

Clinical data from 120 elderly patients who underwent hip fracture surgery between April 1, 2023, and June 30, 2025, were retrospectively analyzed. Patients admitted between April 1, 2023, and September 30, 2023, who received conventional post-anesthesia care were assigned to the conventional group. Patients admitted between October 1, 2023, and June 30, 2025, who received perioperative management based on the ERAS concept were assigned to the ERAS group. The primary outcome measure, the incidence of emergence agitation (EA) within 60 min after extubation, was assessed using the Riker Sedation-Agitation Scale (Riker-SAS). Pain intensity within 60 min post-extubation was evaluated using the Visual Analog Scale (VAS). Secondary outcome measures within 60 min post-extubation were recorded for both groups, including the occurrence of adverse events (hypertension, tachycardia, unplanned extubation), the incidence of hypothermia, emergence time, extubation time, length of PACU stay, time to first ambulation after surgery, total hospital length of stay, and the incidence of postoperative complications. Differences between the two groups were compared in terms of both primary and secondary outcome measures.

Results

Compared to the conventional group, the observation group demonstrated significantly lower Riker Sedation-Agitation Scale (Riker-SAS) scores, Visual Analog Scale (VAS) pain scores, incidence of emergence hypothermia, emergence time, extubation time, duration of stay in the post-anesthesia care unit (PACU), time to first postoperative ambulation, and total hospital length of stay (P < 0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P > 0.05).

Conclusions

A perioperative management strategy based on the ERAS concept may be associated with a reduced incidence of emergence agitation in elderly patients undergoing hip fracture surgery under general anesthesia.

Graphical Abstract