Effect of unaccompanied care model in postoperative care for elderly patients with lower limb fractures: factors influencing postoperative heart failure.

OBJECTIVE: To evaluate the effect of the unaccompanied care model on postoperative nursing for elderly patients with lower limb fractures (LLFs) and identify factors influencing postoperative heart failure (HF). METHODS: A total of 215 elderly patients diagnosed with LLFs who received conventional treatment between January and December 2023 were enrolled as the control group. Another 215 elderly patients with LLFs treated from January to December 2024 were included as the observation group, who received unaccompanied care in addition to conventional treatment. RESULTS: At postoperative day 7 and month 6, the observation group obtained significantly higher Fugl-Meyer Assessment for lower limb motor function and Barthel Index for activities of daily living than the control group (both P < 0.001). On postoperative day 7, the observation group had a higher left ventricular ejection fraction (LVEF), lower left ventricular end-diastolic diameter (LVEDD) and lower B-type natriuretic peptide (BNP) levels relative to the control group (all P < 0.01). At postoperative month 6, the observation group showed superior left ventricular end-systolic diameter (LVESD), LVEDD, LVEF, and BNP profiles compared to the control group (all P < 0.01). In addition, the observation group had higher serum Klotho and decoy receptor 3 levels and lower salusin-β levels at postoperative month 6 (all P < 0.05). The observation group also had significantly shorter affected limb swelling regression time, earlier off-bed ambulation time, and shorter hospital stay (all P < 0.05). The overall complication rate was 21.4% in the observation group versus 33.5% in the control group (P < 0.05). Multivariate analysis demonstrated that advanced age, American Society of Anesthesiologists (ASA) physical status classification, preoperative BNP level and Klotho level were independent risk predictors of postoperative HF in elderly patients undergoing lower limb fracture surgery (all P < 0.05). The established nomogram presented good discriminatory power [area under the curve (AUC) = 0.879] and calibration performance, and SHAP analysis further verified the predictive validity of the model. CONCLUSION: The unaccompanied care model can improve lower limb motor function, activities of daily living and cardiac function, ameliorate abnormal serum inflammatory biomarker levels, and reduce postoperative complication risks for elderly patients with LLFs. Age, ASA classification, BNP and Klotho were independent predictors of postoperative HF. The nomogram model has robust predictive performance and promising clinical application value.