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.
Copyright © 2020 Elsevier Ltd. All rights reserved.
Dabigatran in Patients With Myocardial Injury After Non-Cardiac Surgery (MANAGE): An International, Randomised, Placebo-Controlled TrialPJ Devereaux et al. Lancet 391 (10137), 2325-2334. PMID 29900874. - Clinical TrialBoehringer Ingelheim and Canadian Institutes of Health Research.
Rationale and Design of the HIP Fracture Accelerated Surgical TreaTment And Care tracK (HIP ATTACK) Trial: A Protocol for an International Randomised Controlled Trial Evaluating Early Surgery for Hip Fracture PatientsFK Borges et al. BMJ Open 9 (4), e028537. PMID 31048449.NCT02027896; Pre-results.
Accelerated Care Versus Standard Care Among Patients With Hip Fracture: The HIP ATTACK Pilot TrialHip Fracture Accelerated Surgical Treatment and Care Track (HIP ATTACK) Investigators. CMAJ 186 (1), E52-60. PMID 24246589. - Randomized Controlled TrialOf patients eligible for inclusion, 80% consented and were randomly assigned to groups (30 to accelerated care and 30 to standard care) at 2 centres in Canada and 1 centr …
Red Blood Cell Transfusion for People Undergoing Hip Fracture SurgerySJ Brunskill et al. Cochrane Database Syst Rev (4), CD009699. PMID 25897628. - ReviewWe found low quality evidence of no difference in mortality, functional recovery or postoperative morbidity between 'liberal' versus 'restrictive' thresholds for red bloo …
Nutritional Supplementation for Hip Fracture Aftercare in Older PeopleA Avenell et al. Cochrane Database Syst Rev 11 (11), CD001880. PMID 27898998. - ReviewThere is low-quality evidence that oral multinutrient supplements started before or soon after surgery may prevent complications within the first 12 months after hip frac …