Hip fracture: accelerated surgery fails to cut mortality or major complications in HIP ATTACK trial

  • Lancet

  • Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • Accelerated surgery (operating within 6 hours of a hip fracture diagnosis) failed to improve survival and major complications vs standard care in the international HIP ATTACK trial.
  • Some secondary outcomes were improved with accelerated surgery.

Why this matters

  • This is the first large trial of accelerated surgery, with findings that contradict results of 2 observational studies.
  • 1.5 million adults per year worldwide experience hip fracture, 95% of whom are managed surgically in high-income countries.

Study design

  • Randomized controlled trial of accelerated surgery (n=1487) vs standard care (n=1483).
  • Coprimary outcomes (within 90 days): mortality and a composite outcome for major complications (fatal and nonfatal myocardial infarction, stroke, venous thromboembolism, sepsis, pneumonia, life-threatening bleeding, and major bleeding).
  • Funding: Canadian Institutes of Health Research.

Key results

  • Accelerated surgery succeeded in getting patients to surgery sooner:
    • Median of 6 (interquartile range, 4-9) vs 24 (10-42) hours for standard care (P<.0001>
  • No differences between groups in:
    • 90-day mortality rate:
      • 9% vs 10% in standard care (HR, 0.91; 95% CI, 0.72-1.14).
    • Major complications:
      • 22% vs 22% (HR, 0.97; 95% CI, 0.83-1.13).
  • Accelerated surgery (vs standard care) was associated with less delirium (P=.0089), stroke (P=.047), and infection without sepsis (P=.032).

Limitations

  • 3 participating hospitals had data quality issues.