Background: Patients diagnosed with a hip fracture are at substantial risk of major complications and mortality. Observational studies have suggested that accelerated surgery for a hip fracture is associated with lower risk of mortality and major complications.
Dr. Bahnsen P. Miller
Study design: International, randomized, controlled trial (RCT).
Setting: 69 hospitals in 17 countries.
Synopsis: This RCT enrolled 2,970 patients with a hip fracture, aged 45 years and older. The median time from hip fracture diagnosis to surgery was 6 h in the accelerated surgery group (n = 1,487) and 24 h in the standard-care group (n = 1,483). A total of 140 (9%) patients assigned to accelerated surgery and 154 (10%) assigned to standard care died at 90 days after randomization (P = .40). Composite of major complications (mortality, nonfatal MI, stroke, venous thromboembolism, sepsis, pneumonia, life-threatening bleeding, and major bleeding) occurred in 321 (22%) patients assigned to accelerated surgery and 331 (22%) assigned to standard care at 90 days after randomization (p = .71). However, accelerated surgery was associated with lower risk of delirium, urinary tract infection, andmoderate to severe pain and resulted in faster mobilization and shorter length of stay.
Practical limitations include the additional resources needed for an accelerated surgical pathway such as staffing and operating room time. Furthermore, this study included only patients diagnosed during regular working hours.
Bottom line: Among patients with a hip fracture, accelerated surgery did not lower the risk of the coprimary outcomes of mortality or a composite of major complications at 90 days compared with standard care.
Citation: Borges F et al. Accelerated surgery versus standard care in hip fracture (HIP ATTACK): An international, randomised, controlled trial. Lancet. 2020 Feb 29; 395(10225), 698-708.
Dr. Miller is assistant professor of medicine, section of hospital medicine, at the University of Virginia School of Medicine, Charlottesville.
