Risk Early Warning Management for Postoperative Hip Fracture Rehabilitation and Delirium Prevention in Elderly Patients

People's Hospital Affiliated to Hubei University of Medicine

Status: Completed

Conditions: Hip Fractures (ICD-10 72.01-72.2)

Treatments: Behavioral: Standard Perioperative Care; Behavioral: Risk Early Warning Management

Study type: Observational

Funder types: Other

Identifiers

NCT06966947

PeoplesHospitalHubei

Details and patient eligibility

About

This clinical study aims to evaluate the effectiveness of a perioperative risk early warning management strategy in patients undergoing surgical treatment for hip fractures. Hip fractures are common in elderly individuals and are associated with a high risk of postoperative complications. Traditional perioperative care may not sufficiently identify and respond to early signs of clinical deterioration.

In this study, patients with hip fractures admitted to the orthopedic department of a single hospital from January 2023 to December 2023 were divided into two groups based on their admission time. Patients admitted between June and December 2023 received the early warning risk management intervention (experimental group), while those admitted between January and May 2023 received routine perioperative care (control group). The early warning management system involved a scoring-based approach using vital signs such as heart rate, respiratory rate, blood pressure, body temperature, and consciousness level to classify patients' risk levels. Nursing staff responded with graded interventions, including enhanced monitoring and rapid physician notification for higher-risk patients.

The study retrospectively enrolled 284 patients in total, with 142 in each group. The primary outcomes include changes in coagulation function, self-care ability (measured by the Exercise of Self-care Agency Scale, ESCA), and hip joint functional recovery (measured by the Hospital for Special Surgery, HSS, score). Secondary outcomes include patient satisfaction and incidence of postoperative complications.

The central hypothesis is that perioperative risk early warning management will improve patient safety, enhance self-care capacity, reduce complications, and promote better recovery outcomes compared to routine care.

Enrollment: 284 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Diagnosed with unilateral intertrochanteric fracture of the femur confirmed by imaging.
• Age 18 years or older.
• Met the indications for surgical treatment and underwent fracture surgery in the study hospital.
• Stable vital signs and clear consciousness postoperatively.

Exclusion criteria

• Presence of hematologic diseases such as coagulation dysfunction.
• Existing lower limb disability, invasive trauma, or other comorbid lesions.
• History of mental disorders, cognitive impairment, or poor compliance with treatment protocols.

Trial design

284 participants in 2 patient groups

Risk Early Warning Perioperative Management

Description:

Participants in this arm received a structured risk early warning management intervention during the perioperative period. The intervention included the establishment of a dedicated nursing team, systematic evaluation of vital signs (heart rate, respiratory rate, blood pressure, temperature, and consciousness), and scoring of patient condition based on a predefined risk assessment table. Based on the risk score, patients received tiered monitoring and intervention: Score 0-4: Routine care and monitoring Score 5-7 or single item score = 3: Intensive monitoring every 4 hours and physician notification Score ≥7: Continuous monitoring, immediate physician arrival, and bedside emergency preparedness This strategy aimed to detect and respond to patient deterioration early, thereby reducing complications and improving recovery outcomes.

Treatment:

Behavioral: Risk Early Warning Management

Routine Perioperative Management

Description:

Participants in this arm received standard perioperative care according to hospital guidelines. This included general health education prior to surgery, assistance during the perioperative period, routine postoperative care such as anticoagulation and infection prevention, regular vital signs monitoring, and standard nursing interventions. No specific early warning risk scoring or tiered response strategy was implemented.

Treatment:

Behavioral: Standard Perioperative Care