Accelerated time to surgery – within an average of 6 hours after a hip fracture diagnosis – resulted in a lower risk of delirium and urinary tract infections, moderate to severe pain, faster mobilization, and a shorter length of hospital stay compared to standard care – when surgery occurred an average of 24 hours after a hip fracture diagnosis, according to researchers.

The HIP Fracture Accelerated Surgical TreaTment And Care tracK (HIP ATTACK) Trial, presented recently at the Orthopaedic Research Society (ORS) 2020 Annual Meeting and published in The Lancet, was led by researchers of the Population Health Research Institute (PHRI) of McMaster University and Hamilton Health Sciences (HHS) in Hamilton, Canada. HIP ATTACK involved 2,970 people at 69 sites in 17 countries, according to a media release from Population Health Research Institute.

Ten years ago, Dr PJ Devereaux – principal investigator of the HIP ATTACK trial, as well as senior scientific lead of PHRI’s perioperative and surgery program, professor of medicine at McMaster, and cardiologist with HHS – was consulted to manage a 73-year-old female with a hip fracture who also had an elevated blood test (troponin) demonstrating heart injury. The referring doctor told Devereaux the patient’s heart issue had to be treated before surgery for her hip fracture could occur. Despite the best of intentions, with the medical treatment Devereaux provided based on current practice at that time, the patient died before she was able to undergo surgery for her hip fracture.

Upon reflecting on this case, Devereaux wondered if the prevailing dogma regarding the need to medically optimize patients before hip fracture surgery was the wrong approach. He contacted Dr Mohit Bhandari, co-principal investigator of HIP ATTACK and an orthopedic surgeon in Hamilton, to get his perspective on the case.

Bhandari told Devereaux that observational studies suggested that shorter time to surgery may prevent death and major complications in patients with a hip fracture. Based on this evidence, they initiated a large randomized controlled trial to understand the effects of accelerated surgery in patients with a hip fracture, the release explains. 

Accelerated surgery did not result in a reduction in death or a collection of major complications. However, patients randomized to accelerated surgery had a lower risk of delirium, urinary tract infection, moderate to severe pain, and were faster to stand, mobilize, and go home compared to patients randomized to standard care.

Among patients who had an elevated blood test (troponin) demonstrating heart injury when they presented to the hospital with their hip fracture, accelerated surgery lowered the risk of death compared to standard care.

“Patients find waiting for hip fracture surgery undesirable because they are forced to lie flat in a bed, go without food, and they are either in pain or receiving pain medications that commonly have negative side effects,” Bhandari notes.

“The lower risk of death with accelerated surgery, in patients who had evidence of a heart injury at the time of hospital admission, challenges the dogma of medical optimization before surgery. Further research should explore the benefits of accelerated surgery in this high-risk group,” Devereaux concludes, in the release.

[Source(s): Population Health Research Institute, PR Newswire]