Enhanced Recovery Nursing for Delirium and Functional Recovery After Femoral Neck Fracture Surgery in Older Adults

Background: Postoperative delirium and impaired rehabilitation are major challenges in elderly femoral neck fracture patients. Enhanced recovery nursing (ERN) protocols emphasizing early mobilization and cognitive support may mitigate these complications. Purpose: This study evaluated the impact of a perioperative ERN model on delirium incidence, sleep quality, recovery milestones, and long-term functional outcomes. Methods: In a retrospective observational study, 254 patients (≥65 years) undergoing hemiarthroplasty or total hip arthroplasty for femoral neck fractures were allocated to conventional care ( n = 116) or ERN groups ( n = 138) based on treatment period. Outcomes included delirium incidence (Confusion Assessment Method), sleep quality (Pittsburgh Sleep Quality Index), time to first ambulation, hospital stay, Harris Hip Score, and 36-Item Short Form Survey (SF-36) quality of life at 1 to 12 months postoperatively. Results: The ERN group showed significantly lower cumulative delirium incidence (6.5% vs. 19.8%; risk difference = −13.3%, 95% confidence incidence [CI]: −20.1% to −6.5%, p = .002), shorter time to ambulation (mean difference [MD] = −1.7 days, 95% CI: −2.2 to −1.2), and hospital stay (MD = −1.6 days, 95% CI: −2.3 to −0.9; both p < .001). Sleep quality improved significantly across all time points ( p < .001). Long-term functional recovery was superior in the ERN group, evidenced by higher Harris scores (12-month MD = 4.7, 95% CI: 3.1–6.3) and SF-36 scores (12-month MD = 6.3, 95% CI: 3.9–8.7) at all intervals. Conclusions: The ERN model significantly reduced delirium, accelerated recovery, and improved long-term function and quality of life, supporting its integration into routine perioperative care for elderly femoral neck fracture patients.