Abstract
Background: Observational studies have suggested that accelerated surgery is associated with improved outcomes in patients with a hip fracture. The HIP ATTACK trial assessed whether accelerated surgery could reduce mortality and major complications. Methods: HIP ATTACK was an international, randomised, controlled trial done at 69 hospitals in 17 countries. Patients with a hip fracture that required surgery and were aged 45 years or older were eligible. Research personnel randomly assigned patients (1:1) through a central computerised randomisation system using randomly varying block sizes to either accelerated surgery (goal of surgery within 6 h of diagnosis) or standard care. The coprimary outcomes were mortality and a composite of major complications (ie, mortality and non-fatal myocardial infarction, stroke, venous thromboembolism, sepsis, pneumonia, life-threatening bleeding, and major bleeding) at 90 days after randomisation. Patients, health-care providers, and study staff were aware of treatment assignment, but outcome adjudicators were masked to treatment allocation. Patients were analysed according to the intention-to-treat principle. This study is registered at ClinicalTrials.gov (NCT02027896). Findings: Between March 14, 2014, and May 24, 2019, 27 701 patients were screened, of whom 7780 were eligible. 2970 of these were enrolled and randomly assigned to receive accelerated surgery (n=1487) or standard care (n=1483). The median time from hip fracture diagnosis to surgery was 6 h (IQR 4–9) in the accelerated-surgery group and 24 h (10–42) in the standard-care group (p<0·0001). 140 (9%) patients assigned to accelerated surgery and 154 (10%) assigned to standard care died, with a hazard ratio (HR) of 0·91 (95% CI 0·72 to 1·14) and absolute risk reduction (ARR) of 1% (−1 to 3; p=0·40). Major complications occurred in 321 (22%) patients assigned to accelerated surgery and 331 (22%) assigned to standard care, with an HR of 0·97 (0·83 to 1·13) and an ARR of 1% (−2 to 4; p=0·71). Interpretation: Among patients with a hip fracture, accelerated surgery did not significantly lower the risk of mortality or a composite of major complications compared with standard care. Funding: Canadian Institutes of Health Research.
| Original language | English |
|---|---|
| Pages (from-to) | 698-708 |
| Number of pages | 11 |
| Journal | The Lancet |
| Volume | 395 |
| Issue number | 10225 |
| Early online date | 9 Feb 2020 |
| DOIs | |
| Publication status | Published - 27 Feb 2020 |
Bibliographical note
Funding Information:The study was funded by grants from the Canadian Institutes of Health Research, the Ontario Strategy for Patient Oriented Research Support Unit, the Ontario Ministry of Health and Long-Term Care, the Hamilton Health Sciences Foundation, Physicians' Services Incorporated Foundation, Michael G. DeGroote Institute for Pain Research and Care, Smith & Nephew (to recruit patients in Spain), and Indiegogo Crowdfunding.
Funding Information:
MB reports grants and personal fees from Sanofi and Pendopharma and grants from Ferring, Aphria, and Acumed, outside the submitted work. MW reports personal fees from Stryker Canada outside the submitted work. EG-F reports grants from Smith and Nephew during the conduct of the study; and personal fees from Biocomposite outside the submitted work. JT-H reports grants from Smith and Nephew during the conduct of the study; personal fees from Stryker, Smith and Nephew, and Depuy outside the submitted work. JT-S reports grants from Smith and Nephew during the conduct of the study; and personal fees from Stryker outside the submitted work. MdMV-C and YG-S report grants from Smith and Nephew during the conduct of the study. EP reports personal fees from Roche Diagnostics outside the submitted work. PJD reports grants from Canadian Institutes of Health Research and from Ontario Strategy for Patient Oriented Research Support Unit/Ministry of Health and Long-Term Care during the conduct of the study; and grants from Abbott Diagnostics, Boehringer Ingelheim, Philips Healthcare, Roche Diagnostics, and Siemens outside the submitted work. All other authors declare no competing interests.