Effect of perioperative psychological intervention on recovery in elderly hip fracture patients with comorbid post-traumatic stress disorder

Abstract

BACKGROUND

Hip fracture in elderly patients, particularly those with comorbid post-traumatic stress disorder (PTSD), presents a significant clinical challenge. In addition to the physiological stress of surgery, these patients often endure psychological burdens that may adversely affect postoperative recovery. The potential benefits of targeted perioperative psychological interventions have not been fully elucidated in this special population. This study hypothesized that a structured perioperative psychological program would improve recovery outcomes, including postoperative pain, functional outcomes, and mental well-being.

AIM

To evaluate the impact of perioperative psychological intervention on postoperative outcomes among elderly patients with PTSD undergoing hip fracture surgery.

METHODS

Between January 1, 2022, and December 31, 2024, medical records of 50 elderly hip fracture patients (age ≥ 65) with PTSD who underwent surgical fixation at our center were retrospectively reviewed. Patients were divided into an intervention (n = 25; standardized psychological care) and control (n = 25; usual care) groups. Data collected included demographics, fracture type, PTSD severity, and anesthesia details. The intervention comprised preoperative counseling, relaxation training, and postoperative coping sessions. Postoperative outcomes compared included pain, PTSD severity, activities of daily living scores, complications, length of stay, mental health, and functional recovery.

RESULTS

The groups had comparable demographic and clinical characteristics. The intervention group demonstrated significantly lower pain scores on postoperative days 3 and 7 (P < 0.01), fewer moderate-to-severe depressive symptoms (P < 0.05), and a greater reduction in PTSD severity (P < 0.01) compared with the control group. Furthermore, the intervention group exhibited improved activities of daily living scores at 4 weeks post-surgery and a lower postoperative complication rate (16% vs 32%, P = 0.14). The average length of hospital stay was shorter in the intervention group (11.5 ± 2.0 days vs 13.1 ± 2.6 days, P < 0.05).

CONCLUSION

In elderly hip fractures patients with comorbid PTSD, perioperative psychological interventions improved pain control, functional recovery, and PTSD symptoms, supporting its value in holistic perioperative management and outcome enhancement.

Keywords: Elderly hip fracture; Post-traumatic stress disorder; Perioperative psychological intervention; Postoperative recovery; Pain management; Functional outcomes

Core Tip: Elderly hip fracture patients with comorbid post-traumatic stress disorder face unique recovery challenges. This retrospective study highlights the benefits of structured perioperative psychological intervention, demonstrating significant improvements in pain management, functional recovery, and post-traumatic stress disorder symptom reduction. Patients receiving psychological support reported lower pain scores, fewer depressive symptoms, enhanced activities of daily living, and shorter hospital stays. These findings suggest that integrating psychological care into perioperative management may optimize outcomes and overall patient well-being in this vulnerable population.