Langenbeck's Archives of Surgery · Nov 9, 2026
Effects of empowerment-based comprehensive nursing on postoperative function, quality of life, and complications in older adults with hip fracture: a randomized controlled trial
By Wang J, Guo Y, Wang H
Background Hip fracture in older adults is associated with substantial morbidity, functional decline, and postoperative complications. Although enhanced recovery after surgery (ERAS) pathways improve perioperative care, variability in functional recovery and persistent post-discharge complications remain. Patient engagement and self-efficacy are key determinants of rehabilitation outcomes but are often inadequately addressed. Empowerment-based nursing, emphasizing active participation and self-management, has shown benefits in chronic disease and rehabilitation settings. However, its effectiveness within ERAS-based care for hip fracture is unclear. Objective To evaluate the effects of empowerment-based comprehensive nursing (EBCN) on postoperative function, quality of life, and complications in older patients undergoing hip fracture surgery within a unified ERAS framework. Methods In this single-center randomized controlled trial, 130 patients aged ≥ 65 years with hip fracture were randomly assigned to receive either standard ERAS-based nursing care or EBCN in addition to ERAS. The primary outcome was functional recovery assessed by the modified Harris Hip Score (mHHS) at 90 days. Secondary outcomes included health-related quality of life (SF-36), rehabilitation efficiency, self-efficacy, and postoperative complications. Results Compared with the control group, patients receiving EBCN showed significantly higher mHHS at discharge and 90 days, improved quality of life, and higher self-efficacy. EBCN was associated with a lower incidence of falls within 30 days and between 31 and 90 days after discharge. Lower readmission and wound infection rates were also observed between 31 and 90 days after discharge. However, not all complication endpoints reached statistical significance across all postoperative time windows. Conclusion EBCN may provide additional benefits beyond standard ERAS care by improving early functional recovery, quality of life, and self-efficacy in older patients after hip fracture surgery. It may also reduce selected postoperative complications during specific follow-up periods.