OBJECTIVES

: Enhanced recovery programs (ERPs) are intended to optimize patient recovery. The purpose of this study was to present the clinical, patient-reported outcome measures (PROMs) and economic outcomes associated with ERPs for fragility fractures of the hip.

METHODS

: A systematic literature review investigating fragility fracture ERPs in Europe, Middle East and Africa, published 2012-2017, was conducted in MEDLINE and other sources.

RESULTS

: Four publications were identified; 3 observational studies and one clinical guideline. All 3 studies were multi-arm comparing ERPs vs non-ERPs. The guideline, by the Association of Anesthetists of Great Britain and Ireland, supported the use of ERPs in proximal femoral fractures.

Time to surgical repair of the fracture was significantly reduced for ERP vs non-ERP in 2 studies (p<0.001 for both), in the third the time to surgery was numerically similar.

In 2 studies, the inclusion of ERP resulted in a significant reduction in length of stay (LOS) of 3-4.2 days (p<0.001 and p=0.013, respectively), while in the third there was a numerical reduction of 1.5 days between the ERP and non-ERP groups (p=0.2).

One study reported readmission rate for fragility fracture patients, with no significant differences at 30 days, 90 days and 1 year after surgery between ERP and non-ERP groups.

ERPs did not compromise patient safety compared to non-ERPs, as indicated by a 2% improvement in post-operative morality in one study, and an improvement in total mortality at 30 day, 90 day and 1 year time-points in another study.

No studies reported on PROMs or economic outcomes.

CONCLUSIONS

: Time to surgery after fracture in the elderly is an important predictor of mortality. Overall, the available evidence suggests that fragility fracture ERPs may improve time to surgery, patient mortality and LOS, without compromising readmission rates. However, the evidence is limited and more research is required.