# Construction and application of an evidence-based prevention and management protocol for postoperative hypoxemia in elderly patients with hip fractures

## TL;DR

This study created and tested a protocol to prevent and manage low oxygen levels after hip surgery in elderly patients, showing improved outcomes and healthcare professional knowledge.

## Contribution

A novel evidence-based protocol for postoperative hypoxemia in elderly hip fracture patients, validated through clinical implementation.

## Key findings

- The protocol significantly improved postoperative oxygen saturation levels in elderly hip fracture patients.
- Hypoxemia incidence was significantly reduced after protocol implementation.
- Healthcare professionals' knowledge scores increased significantly following the protocol's use.

## Abstract

To develop an evidence-based practice protocol for the prevention and management of postoperative hypoxemia in elderly patients with hip fracture and to evaluate its clinical effectiveness.

Utilizing evidence-based nursing methodology, we systematically retrieved, appraised, and synthesized the best available evidence regarding the prevention and management of postoperative hypoxemia in this patient population. Guided by a knowledge translation framework, an evidence-based practice protocol was developed. Elderly hip fracture patients undergoing surgery at a tertiary hospital in Ningxia were enrolled from January-April 2024 (baseline/pre-implementation group, n = 52) and June-September 2024 (post-implementation group, n = 52). Peripheral oxygen saturation (SpO2) was measured at key time points: upon entering the operating room, upon returning to the ward, and on postoperative days (POD) (1) and (2). Comparisons were made between groups regarding SpO2 changes, incidence of hypoxemia (SpO2 < 90%), and healthcare professionals’ (HCPs) knowledge scores.

Repeated-measures ANOVA revealed significant main effects of time (F = 18.177, p < 0.001) and group (F = 38.818, p < 0.001), as well as a significant time*group interaction (F = 29.865, p < 0.001) on SpO2. Multivariate ANOVA showed significantly higher SpO2 in the post-implementation group compared to the pre-implementation group on POD1 (F = 18.870, p < 0.001) and POD2 (F = 205.270, p < 0.001). The incidence of hypoxemia was significantly reduced in the post-implementation group on POD1 (1.92% vs. 13.46%, χ2 = 4.875, p = 0.027) and POD2 (0.00% vs. 19.23%, χ2 = 11.064, p = 0.001). Additionally, HCPs’ knowledge scores significantly increased following protocol implementation (91.54 ± 4.90 vs. 73.08 ± 6.35, t = 16.59, p < 0.001).

The evidence-based protocol for preventing and managing postoperative hypoxemia effectively enhanced clinical decision-making, improved postoperative SpO2 levels, reduced hypoxemia incidence, and enhanced HCPs’ knowledge. These findings support the protocol’s feasibility and effectiveness for clinical implementation in elderly hip fracture patients.