Accelerated surgery versus standard care in hip fracture (HIP ATTACK): an international, randomised, controlled trial



Summary

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.

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Article Info

Publication History

Published: February 09, 2020

Identification

DOI: https://doi.org/10.1016/S0140-6736(20)30058-1

Copyright

© 2020 Elsevier Ltd. All rights reserved.

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