Background: The incidence of total hip arthroplasty (THA) is dramatically increasing, particularly in older adults. Enhanced recovery after surgery (ERAS) has been used in the postoperative care of patients undergoing surgical treatment.

Aims: This study compared the effects of ERAS and regular nursing on older adult patients undergoing THA to evaluate ERAS's potential in patients' postoperative care.

Methods: Ninety older adult patients (age ≥ 60 years) who underwent THA were enrolled and randomly divided into two groups: regular and ERAS nursing strategies. The ERAS nursing strategy was optimized based on regular nursing in terms of pain management, nutrition management, intestinal preparation, drainage tube nursing, catheter nursing, and normothermia maintenance. The efficiency of the two nursing strategies was evaluated from the perspectives of postoperative pain, hospitalization conditions, hip function, daily life ability, complications, and satisfaction.

Results: The ERAS group showed earlier first aerofluxus, getting out of bed, and defecation; the moving distance after getting out of bed was greater than that in the regular group. The removal of urinary and drainage tubes was also earlier in the ERAS group than in the regular group. ERAS significantly alleviated postoperative pain, increased Harris scores and the Barthel index, reduced hospitalization duration and expenses, and lowered the occurrence of complications. The ERAS group also showed higher satisfaction levels than the regular group.

Conclusions: This single-blind randomized controlled trial showed that the ERAS nursing strategy reduced pain, length and cost of hospital stay, and incidence of complications after THA compared with regular care. Therefore, ERAS nursing strategies are recommended to improve the postoperative recovery rates in older adult patients undergoing THA.