Objective To investigate the effects of accelerated rehabilitation surgery on short-term surgical effect and stress response in the middle-age and elderly patients with intertrochanteric fractures treated by internal fixation of proximal femoral nail antirotation(PFNA). Methods A total of 92 middle-aged and elderly (age≥55 years) patients with femoral intertrochanteric fracture were selected for analysis, who were treated with PFNA fixation in Xuanhan Shuanghewang Yanhui Hospital from March 2018 to May 2019. The patients were randomly divided into the observation group (n=46) intervened with enhanced recovery after surgery (ERAS) and control group (n=46) with conventional measures. The two groups were compared in the perioperative stress, total perioperative blood loss, time to get out of bed, hospital stay, and incidence of perioperative complications. The hip Harris scores at postoperative 1 month and 3 months were recorded. SPSS statistics 24.0 was used for statistical analysis. Data comparison between two groups was perfomed using χ² test or t test depending on data type. Results After the operation, the observation group showed lower incidence of △SBP≥20 mmHg, △DBP≥20 mmHg and △HR≥20 times/min, lower levels than serum noradrenaline and angiotensin Ⅱ, but higher serum level of superoxide dismutase than the control group (P<0.05 for all). Harris scores at postoperative 3 months were much enhanced in both groups but were significantly higher in observation group than in the control group (P<0.05). The observation group had less total perioperative blood loss, shorter time to get out of bed, shorter hospital stay, and lower incidence of perioperative complications than in the control group (P<0.05). Conclusion For the middle aged and elderly (age ≥55years) patients treated with PFNA internal fixation for the intertrochanteric fracture, ERAS can effectively reduce the stress response and enhance the functional recovery of the hip joint.