Economic analysis of early nutritional intervention combined with acupoint electrical stimulation in elderly patients undergoing total hip arthroplasty: a Monte Carlo validation_West China Medical Journal

Authors：

ZHOU Hongyu ¹ , CHEN Gejun ² , WANG Chen ³ , CHEN Huan ⁴ ,  DAI Chuanqiang ⁵

1. Nutrition Department, Ziyang Central Hospital, Ziyang, Sichuan 641300, P. R. China;
2. Outpatient Department, Ziyang Central Hospital, Ziyang, Sichuan 641300, P. R. China;
3. Urology Department, Ziyang Central Hospital, Ziyang, Sichuan 641300, P. R. China;
4. Orthopedics Department, Ziyang Central Hospital, Ziyang, Sichuan 641300, P. R. China;
5. Medical Affairs Department, Ziyang Central Hospital, Ziyang, Sichuan 641300, P. R. China;

Corresponding?author：

DAI Chuanqiang, Email: 39513410@qq.com

Keywords：

Nutritional intervention; transcutaneous acupoint electrical stimulation; elderly; total hip arthroplasty

DOI：

10.7507/1002-0179.202510220

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Objective To investigate the comprehensive efficacy and cost-effectiveness of early nutritional intervention combined with acupoint electrical stimulation under the enhanced recovery after surgery (ERAS) concept in elderly patients undergoing total hip arthroplasty (THA), and to verify the robustness of the results through Monte Carlo validation. Methods Elderly patients who underwent THA in the Ziyang Central Hospital between January 2022 and December 2024 were retrospectively selected. Patients who did not implement the ERAS protocol between January and December 2022 were included in the control group, while patients who implemented the ERAS protocol between January 2023 and December 2024 were included in the intervention group. Total hospitalization costs, postoperative complication rates, patient satisfaction, and clinical indicators were collected to construct a comprehensive efficacy score. Monte Carlo validation was used to analyze the incremental cost-effectiveness ratio and parameter uncertainty. Results A total of 140 patients were enrolled, with 70 in each group. There were no statistically significant differences in gender, age, and preoperative indicators between the two groups (P>0.05). The Richmond Agitation-Sedation Scale scores [(?0.03±0.87) vs. (0.53±0.85) points; P<0.05] and the incidence of agitation [5.7% (4/70) vs. 34.3% (24/70); P<0.05] were lower in the intervention group compared to the control group. The total incidence of adverse reactions in the postoperative intervention group [5.7% (4/70) vs. 18.6% (13/70); P<0.05] was lower than that in the control group. The comprehensive efficacy score, hospitalization costs, and cost-effectiveness ratio were all superior in the intervention group compared to the control group (P<0.05). Monte Carlo validation results further confirmed the advantages of early nutrition combined with acupoint electrical stimulation in improving cost-effectiveness. Conclusions ERAS-based early nutritional intervention combined with acupoint electrical stimulation can significantly enhance the comprehensive efficacy and reduce medical costs in elderly THA patients. Monte Carlo validation verifies the robustness of its cost-effectiveness, providing health economic evidence for clinical decision-making.

Citation： ZHOU Hongyu, CHEN Gejun, WANG Chen, CHEN Huan, DAI Chuanqiang. Economic analysis of early nutritional intervention combined with acupoint electrical stimulation in elderly patients undergoing total hip arthroplasty: a Monte Carlo validation. West China Medical Journal, 2026, 41(6): 959-963. doi: 10.7507/1002-0179.202510220 Copy

1.	Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg, 2017, 152(3): 292-298.
2.	Soffin EM, YaDeau JT. Enhanced recovery after surgery for primary hip and knee arthroplasty: a review of the evidence. BrJ Anaesth, 2016, 117(suppl 3): iii62-iii72.
3.	Morrell AT, Layon DR, Scott MJ, et al. Enhanced recovery after primary total hip and knee arthroplasty: a systematic review.J Bone Joint Surg Am, 2021, 103(20): 1938-1947.
4.	曹暉, 陳亞進, 顧小萍, 等. 中國加速康復外科臨床實踐指南(2021 版). 中國實用外科志, 2021, 41(9): 961-992.
5.	Venishetty N, Beale J, Martinez J, et al. Understanding factors that impact the length of stay after total hip arthroplasty – a national in-patient sample-based study. J Clin Orthop Trauma, 2023, 46: 102284.
6.	段丹, 寧寧, 周宗科, 等. 全髖、膝關節置換術后患者隨訪現狀的研究進展. 護士進修雜志, 2021, 36(18): 1664-1667.
7.	鄭澤煒, 葉凱靜, 張闊, 等. 全髖關節置換后的低蛋白血癥: 危險因素及列線圖預測模型建立. 中國組織工程研究, 2025, 29(15):3147-3152.
8.	White JJ, Houghton-Clemmey R, Marval P. Enhanced recovery after surgery (ERAS): an orthopaedic perspective. J Perioper Pract, 2013, 23(10): 228-232.
9.	周宗科, 翁習生, 曲鐵兵, 等. 中國髖、膝關節置換術加速康復——圍術期管理策略專家共識. 中華骨與關節外科雜志, 2016, 9(1): 1-9.
10.	莊珊珊, 張轉運, 傅雙, 等. 擇期全麻患者術前禁食禁飲管理的最佳證據總結. 中華護理雜志, 2022, 57(14): 1749-1755.
11.	武曉冬, 黃龍祥, 趙京生. 《經穴名稱與定位》(GB/T 12346-2021)標準解讀. 中國針灸, 2022, 42(5): 579-582, 584.
12.	李肖肖, 鄧林琳, 聶芳, 等. 應用 Richmond 躁動鎮靜評分對顱腦損傷躁動患者進行目標鎮靜的效果. 中國醫科大學學報, 2019, 48(5): 464-466.
13.	趙榕婷, 盛蕾. 水中運動康復對膝關節損傷患者功能恢復的影響. 體育與科學, 2023, 44(2): 110-120.
14.	王凱蓉, 周英鳳, 張曉菊, 等. 兩種中心靜脈輸液技術的成本效果分析. 中華護理雜志, 2021, 56(4): 574-581.
15.	劉洋, 李志強, 韓勇. 基于云模型和蒙特卡洛方法的醫院運營評價. 統計與決策, 2019, 35(5): 181-184.
16.	劉兵, 池宜興, 曾建麗, 等. 空間科學衛星工程項目進度及風險分析: 基于蒙特卡洛模擬仿真. 科技管理研究, 2021, 41(13): 158-166.
17.	逯進, 華玉飛, 王秋蘇. 貨幣政策、資產價格與消費者價格波動: 基于庇古效應和超調理論的研究. 管理科學學報, 2024, 27(1): 126-140.
18.	Wainwright TW et al. Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: enhanced recovery after surgery (ERAS^?) society recommendations. Acta Orthop, 2020, 91(3): 363.
19.	栗浩, 文謙, 胡航綺, 等. 經皮穴位電刺激聯合電針促進腹部手術后快速康復: 隨機對照試驗. 中國針灸, 2023, 43(2): 135-140.

1. Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg, 2017, 152(3): 292-298.
2. Soffin EM, YaDeau JT. Enhanced recovery after surgery for primary hip and knee arthroplasty: a review of the evidence. BrJ Anaesth, 2016, 117(suppl 3): iii62-iii72.
3. Morrell AT, Layon DR, Scott MJ, et al. Enhanced recovery after primary total hip and knee arthroplasty: a systematic review.J Bone Joint Surg Am, 2021, 103(20): 1938-1947.
4. 曹暉, 陳亞進, 顧小萍, 等. 中國加速康復外科臨床實踐指南(2021 版). 中國實用外科志, 2021, 41(9): 961-992.
5. Venishetty N, Beale J, Martinez J, et al. Understanding factors that impact the length of stay after total hip arthroplasty – a national in-patient sample-based study. J Clin Orthop Trauma, 2023, 46: 102284.
6. 段丹, 寧寧, 周宗科, 等. 全髖、膝關節置換術后患者隨訪現狀的研究進展. 護士進修雜志, 2021, 36(18): 1664-1667.
7. 鄭澤煒, 葉凱靜, 張闊, 等. 全髖關節置換后的低蛋白血癥: 危險因素及列線圖預測模型建立. 中國組織工程研究, 2025, 29(15):3147-3152.
8. White JJ, Houghton-Clemmey R, Marval P. Enhanced recovery after surgery (ERAS): an orthopaedic perspective. J Perioper Pract, 2013, 23(10): 228-232.
9. 周宗科, 翁習生, 曲鐵兵, 等. 中國髖、膝關節置換術加速康復——圍術期管理策略專家共識. 中華骨與關節外科雜志, 2016, 9(1): 1-9.
10. 莊珊珊, 張轉運, 傅雙, 等. 擇期全麻患者術前禁食禁飲管理的最佳證據總結. 中華護理雜志, 2022, 57(14): 1749-1755.
11. 武曉冬, 黃龍祥, 趙京生. 《經穴名稱與定位》(GB/T 12346-2021)標準解讀. 中國針灸, 2022, 42(5): 579-582, 584.
12. 李肖肖, 鄧林琳, 聶芳, 等. 應用 Richmond 躁動鎮靜評分對顱腦損傷躁動患者進行目標鎮靜的效果. 中國醫科大學學報, 2019, 48(5): 464-466.
13. 趙榕婷, 盛蕾. 水中運動康復對膝關節損傷患者功能恢復的影響. 體育與科學, 2023, 44(2): 110-120.
14. 王凱蓉, 周英鳳, 張曉菊, 等. 兩種中心靜脈輸液技術的成本效果分析. 中華護理雜志, 2021, 56(4): 574-581.
15. 劉洋, 李志強, 韓勇. 基于云模型和蒙特卡洛方法的醫院運營評價. 統計與決策, 2019, 35(5): 181-184.
16. 劉兵, 池宜興, 曾建麗, 等. 空間科學衛星工程項目進度及風險分析: 基于蒙特卡洛模擬仿真. 科技管理研究, 2021, 41(13): 158-166.
17. 逯進, 華玉飛, 王秋蘇. 貨幣政策、資產價格與消費者價格波動: 基于庇古效應和超調理論的研究. 管理科學學報, 2024, 27(1): 126-140.
18. Wainwright TW et al. Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: enhanced recovery after surgery (ERAS^?) society recommendations. Acta Orthop, 2020, 91(3): 363.
19. 栗浩, 文謙, 胡航綺, 等. 經皮穴位電刺激聯合電針促進腹部手術后快速康復: 隨機對照試驗. 中國針灸, 2023, 43(2): 135-140.

West China Medical Journal

Economic analysis of early nutritional intervention combined with acupoint electrical stimulation in elderly patients undergoing total hip arthroplasty: a Monte Carlo validation

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