Enhanced Recovery After Surgery (ERAS)

Geriatric Orthopedic Hip Fracture ERAS

Appointment New Patient Appointment or 214-645-8300

Goals

  1. Make this an ideal surgical experience for you, the patient.
  2. Incorporate a comprehensive pain regimen including behavioral techniques, medications, and a nerve block to improve your postoperative pain control while decreasing your narcotic needs.
  3. Prevent potential surgical and anesthesia complications.
  4. Reduce the amount of time you’re in the hospital after surgery.
  5. Decrease your likelihood of a future fracture and improve your overall function.

Prior to Surgery

  • Your involvement with the program begins in the Emergency Department if your treatment plan includes surgical repair.
  • We will treat your pain and prepare you for surgery.
  • Patients will be scheduled for surgery as soon as they are medically ready. Our goal is for this to happen within 48 hours of your diagnosis.
  • Your surgeon will meet with you to explain surgical plans and set your expectations.
    • Preparations may include blood tests and other tests based on your existing medical conditions.
    • A nerve block will likely be performed to decrease your pain and need for IV and oral pain medications.
    • Additional pain medications will be given (such as acetaminophen, celecoxib, and others if necessary).
  • On the night before surgery, do not eat solid foods after 11 p.m.
  • You can drink up to 20 ounces of clear liquids (such as water or Gatorade) up to two hours before your surgery start time.

During Surgery

  • You’ll be evaluated by your anesthesia team, which will include an anesthesiologist and possibly a nurse anesthetist. The anesthetic plan will be tailored to you with the goals of optimizing your safety, comfort, and early recovery.
  • You and your anesthesiologist will choose whether you receive spinal or general anesthesia. Your anesthesia team will monitor you very closely throughout the surgery.
  • You will receive multiple medications during surgery to treat pain and nausea.
  • There will be a specific and tailored anesthetic protocol to decrease the stress on your body, improve pain control, and accelerate your recovery.
  • A nerve block might be repeated before or after the procedure. This is designed to decrease your postoperative pain and need for IV and oral pain medications.
  • The whole process, from the time you leave your hospital room until you return to it after surgery, typically takes four to five hours.

After Surgery

  • After surgery, your care team will continue to help enhance your recovery through:
    • Offering physical therapy, occupational therapy, or both, depending on your injury
    • Optimizing your nutrition and diet
    • Treating pain
    • Addressing other medical conditions if you have them
    • Mitigating the risk of post-surgery complications
    • Determining what level of assistance you will need after discharge and where you should receive it
  • We encourage you to get out of bed and sit in a chair for all of your meals. Please ask for help before getting up: “Call, don’t fall.”
  • You'll wear compression boots or stockings that inflate and deflate mechanically. The massaging action helps prevent a blood clot.
  • You'll also use an incentive spirometry device to help expand your lungs.
  • During your recovery, our goal is to try to provide you with the best pain relief we can without using opioids, which can cause a number of side effects.
  • If you need opioid medication to manage pain, your plan will include reducing the amount you take over time until you are able to stop taking them.
  • To avoid delirium, which can be caused by many things during your illness and can be a side effect of opioids, stay connected with people, place, and time; keep your mind active; and keep a regular sleep schedule.
  • You’ll learn more about bone health and how to potentially prevent more fractures.
  • You’ll follow up with your surgeon after surgery and also our Bone Mineral Metabolism team.

Orthopaedics and Rehab

After the fall: RESTORE bone health and prevent future hip fractures in seniors