Enhanced recovery after surgery (ERAS) protocols represent patient-centered, evidence-based, multidisciplinary care of the surgical patient. Although these patterns have been validated in numerous surgical specialities, ERAS has not been widely described for patients undergoing hip fracture (HFx) repair. As part of the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery, we have conducted a full evidence review of interventions that form the basis of the anesthesia components of the ERAS HFx pathway. A literature search was performed for each protocol component, and the highest levels of evidence available were selected for review. Anesthesiology components of care were identified and evaluated across the perioperative continuum. For the preoperative phase, the use of regional analgesia and nonopioid multimodal analgesic agents is suggested. For the intraoperative phase, a standardized anesthetic with postoperative nausea and vomiting prophylaxis is suggested. For the postoperative phase, a multimodal (primarily nonopioid) analgesic regimen is suggested. A summary of the best available evidence and recommendations for inclusion in ERAS protocols for HFx repair are provided.
From the *Department of Anesthesiology, The Hospital for Special Surgery, New York, New York
†Department of Anesthesiology, Weill Cornell Medicine, New York, New York
‡Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
§Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, Baltimore, Maryland
‖Department of Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
¶Department of Anesthesiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
#Department of Anesthesiology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
**Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
††Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland.
Published ahead of print 19 September 2018.
Accepted for publication September 19, 2018.
Funding: This project was funded under contract number HHSP233201500020I from the Agency for Healthcare Research and Quality, US Department of Health and Human Services.
Conflicts of Interest: See Disclosures at the end of the article.
The opinions expressed in this document are those of the authors and do not reflect the official position of the Agency for Healthcare Research and Quality or the US Department of Health and Human Services.
Reprints will not be available from the authors.
Address correspondence to Ellen M. Soffin, MD, PhD, Department of Anesthesiology, The Hospital for Special Surgery, 535 E 70th St, New York, NY 10021. Address e-mail to firstname.lastname@example.org.