Efficacy and safety of fast-track surgical management for acute orthopedic fractures: a retrospective cohort analysis

BACKGROUND: Acute orthopedic fractures pose significant treatment challenges, requiring efficient and effective management to improve patient outcomes. This study compares the efficiency and prognosis of fast-track surgical management versus conventional early definitive treatment in managing acute orthopedic fractures. METHODS: This retrospective cohort study included 116 patients with acute orthopedic fractures treated between June 2024 and June 2025. Patients were assigned to either a fast-track surgical management group (fast-track group, n = 60) or a conventional early definitive treatment group (control group, n = 56). The primary outcome was in-hospital mortality. Secondary outcomes included operation time, intraoperative blood loss, transfusion volume, body temperature recovery time, time to first ambulation, length of hospital stay, hospitalization cost, postoperative pain assessed using the Visual Analog Scale (VAS) at 24, 48, and 72 h, fracture healing quality, postoperative complications, and 6-month health-related quality of life evaluated using the 36-Item Short Form Health Survey (SF-36). Logistic regression analyses were performed to identify factors associated with in-hospital mortality. RESULTS: In-hospital mortality was significantly lower in the fast-track group compared with the control group (5.00% vs. 16.07%, P = 0.044). The fast-track group demonstrated significantly shorter operation time, reduced intraoperative blood loss and transfusion requirements, earlier postoperative ambulation, shorter hospitalization duration, and lower total medical costs (all P < 0.05). VAS scores at 24, 48, and 72 h were consistently lower in the fast-track group (all P < 0.05). The overall complication rate was significantly reduced (5.26% vs. 19.15%, P = 0.027). The good healing rate was higher in the fast-track group (P = 0.013). At 6 months, several SF-36 domains, including physical functioning, role physical, vitality, social functioning, and general health, were significantly higher in the fast-track group (all P < 0.05). Multivariable logistic regression analysis demonstrated that fast-track group remained significantly associated with lower in-hospital mortality (OR = 0.352, 95% CI: 0.118-0.947, P = 0.041), whereas higher Injury Severity Score was an independent risk factor (OR = 1.196, 95% CI: 1.031-1.387, P = 0.018). CONCLUSION: Fast-track surgical management was associated with lower in-hospital mortality, enhanced perioperative efficiency, reduced complications, and improved functional recovery compared with conventional early definitive treatment in patients with acute orthopedic fractures.