HIP Fracture Accelerated Surgical TreaTment And Care tracK (HIP ATTACK) Trial (HIP ATTACK)

HIP ATTACK is an international randomized controlled trial of 3000 patients with a hip fracture that requires a surgical intervention. This trial will determine the effect of accelerated medical clearance and accelerated surgery compared to standard care on the 90-day risk of mortality and major perioperative complication (i.e., a composite of mortality, nonfatal myocardial infarction, nonfatal pulmonary embolism, nonfatal pneumonia, nonfatal sepsis, nonfatal stroke, and nonfatal life-threatening and major bleeding).

Study Overview

• Status: Completed
• Conditions: Hip Fractures
• Intervention / Treatment: Other: Accelerated medical clearance and surgery

• Study Type: Interventional
• Enrollment (Actual): 3001
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Belgium
  • Brussels, Belgium
    • Cliniques Universitaires Saint-luc
  • Woluwe-Saint-Lambert, Belgium
    • Cliniques Universitaires Saint-luc
• Canada
  • Alberta
    • Calgary, Alberta, Canada
      • South Health Campus
    • Edmonton, Alberta, Canada
      • University of Alberta Hospital
  • British Columbia
    • Vancouver, British Columbia, Canada
      • Vancouver General Hospital
  • Manitoba
    • Winnipeg,, Manitoba, Canada, MB R2K 2M9
      • Concordia Hip and Knee Institute
  • Nova Scotia
    • Halifax,, Nova Scotia, Canada, B3H 3A7
      • QEII Health Sciences
  • Ontario
    • Barrie, Ontario, Canada
      • Royal Victoria Hospital
    • Etobicoke, Ontario, Canada
      • Etobicoke General Hospital
    • Hamilton, Ontario, Canada, L8N 4A6
      • St. Joseph's Hospital Hamilton
    • Hamilton, Ontario, Canada, L8V 5C2
      • Hamilton Health Sciences - Juravinski Hospital
    • Kingston, Ontario, Canada, K7L 2V7
      • Kingston General Hospital
    • Kitchener, Ontario, Canada
      • Grand River Hospital
    • London, Ontario, Canada
      • Victoria Hospital, London Health Sciences
    • Markham, Ontario, Canada
      • Markham Stouffville Hospital
    • Ottawa, Ontario, Canada, K1H 8L6
      • Ottawa General Hospital
    • Thunder Bay, Ontario, Canada, P7B 6V4
      • Thunder Bay Regional Health Sciences Centre
    • Toronto, Ontario, Canada, M3M 0B2
      • Humber River Hospital
    • Toronto, Ontario, Canada
      • St. Michael's Hospital
    • Toronto, Ontario, Canada
      • Sunnybrook Health Sciences Centre
• China
  • Beijing, China
    • Beijing ChaoYang Hospital
• Colombia
  • Bogotá, Colombia, 13B-60
    • Fundacion Cardioinfantil
• France
  • Lyon, France
    • Centre Hospitalier Lyon Sud
  • Nîmes Cedex 09, France, 30029
    • Nîmes University Hospital
• Hong Kong
  • High West, Hong Kong
    • Queen Mary Hospital
• India
  • Alappuzha, India, 688005
    • Government TD Medical College
  • Bangalore, India, 560099
    • Sparsh Hospital
  • Chandigarh, India
    • PGIMER
  • Hebbal, India, 560024
    • Bangalore Baptist Hospital
  • Kolkata, India, 700099
    • NH Kolkata
  • Ludhiana, India, 141008
    • CMC Ludhiana
  • Nagpur, India
    • Seven Star Hospital
  • New Delhi, India
    • AIIMS Hospital
  • Puducherry, India
    • JIPMER
  • Shivajinagar, India, 411005
    • Sancheti Institute for Orthopaedics and Rehabilitation
  • Trivandrum, India
    • Government Medical Hospital
• Italy
  • Milan, Italy, 20132
    • Ospedale San Raffaele
  • Milan, Italy
    • Humanitas Research Hospital
  • Milan, Italy
    • IRCCS Galeazzi Orthopedic Institute
  • Varese, Italy
    • ASST Sette Laghi - Ospedale Di
• Malaysia
  • George Town, Malaysia
    • Hospital Pulau Pinang
  • Kuala Lumpur, Malaysia, 59100
    • University Malaya Medical Centre (UMMC)
• Netherlands
  • Deventer, Netherlands
    • Deventer Ziekenhuis
• Pakistan
  • Islāmābād, Pakistan, 44000
    • Shifa International Hospitals
  • Karachi, Pakistan, 74800
    • The Aga Khan University
• Poland
  • Bochnia, Poland
    • SPZOZ Szpital Powiatowy w Bochni im M. Wieckiej
  • Myślenice, Poland, 32-400
    • Samodzielny Publiczny Zakład Opieki Zdrowotnej W Myślenicach
  • Łódź, Poland
    • University Hospital & Educational Center of Medical University in Lodz
• South Africa
  • Cape Town, South Africa
    • Stellenbosch University
  • Cape Town, South Africa, 7925
    • Groote Schuur Hospital
  • Johannesburg, South Africa, 2193
    • Chris Hani Baragwanath Hospital
• Spain
  • Barcelona, Spain, 08208
    • Corporacio Sanitaria Parc Tauli
  • Barcelona, Spain, 08025
    • Hospital San Pau
  • Barcelona, Spain, 08035
    • Hospital Universitaire Vall d'Hebron
  • Barcelona, Spain, 08221
    • Mutua de Terrassa Hospital
  • Barcelona, Spain
    • Hospital Sant Camil (Consorci Sanitari Garraf)
  • Marbella, Spain, 29603
    • Costa del Sol
  • Valladolid, Spain
    • Hospital Clinico Universitario de Vallad
• Thailand
  • Bangkok,, Thailand, 10400
    • Ramathibodi Hospital
• United Kingdom
  • Huddersfield, United Kingdom
    • Calderdale & Huddersfield NHS
  • London, United Kingdom, SW10 9NH
    • Chelsea and Westminster Hospital
  • London, United Kingdom
    • West Middlesex Hospital
  • Peterborough, United Kingdom
    • Peterborough City Hospital
  • Sutton in Ashfield, United Kingdom, NG17 4JL
    • King's Mill Hospital
• United States
  • California
    • San Jose, California, United States
      • Regional Medical Center of San Jose
  • Maryland
    • Baltimore, Maryland, United States, 20742
      • University of Maryland
  • Massachusetts
    • Burlington, Massachusetts, United States, 01805
      • Lahey Hospital and Medical Centre
    • Washington, Massachusetts, United States, 02111
      • Tufts Medical Centre
  • Ohio
    • Columbus, Ohio, United States, 43210
      • Ohio State University Medical Centre

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 45 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• age ≥45 years; and
• diagnosis of hip fracture during working hours with a low-energy mechanism (i.e., falling from standing height) requiring surgery.

Exclusion Criteria:

• patients requiring emergent surgery or emergent interventions for another reason (e.g., subdural hematoma, abdominal pathology requiring urgent laparotomy, acute limb ischemia, other fractures or trauma requiring emergent surgery, necrotising fasciitis, coronary revascularization, pacemaker-implantation);
• open hip fracture;
• bilateral hip fractures;
• peri-prosthetic fracture;
• therapeutic anticoagulation not induced by a Vitamin K Antagonist, unfractionated heparin, (e.g., administration of therapeutic Low Molecular Weight Heparin (LMWH) (>6,000 u/24h) in the 24 hours prior to enrolment, or intake of any other non-reversible oral anticoagulant(s) for which there is no reversing agent available
• patients on a therapeutic vitamin K antagonist with a history of heparin induced thrombocytopenia (HIT);
• patients refusing participation; or
• patients previously enrolled in the study.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Accelerated medical clearance and surgery; Rapid medical clearance with targeted arrival to the operating room within 6 hours of diagnosis of a hip fracture requiring surgical repair.	Other: Accelerated medical clearance and surgery; Rapid medical clearance with targeted arrival to the operating room within 6 hours of diagnosis of a hip fracture requiring surgical repair.
No Intervention: Standard surgical care; Surgical hip fracture repair according to the standard timing.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mortality	All-cause mortality	90 days
Composite - major perioperative complication	Composite of mortality, nonfatal myocardial infarction, nonfatal pulmonary embolism, nonfatal pneumonia, nonfatal sepsis, nonfatal stroke, and nonfatal life-threatening and major bleeding	90 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Length of hospital stay	Length of hospital stay	90 days
All-cause mortality	Death due to all causes	90 days and 1 year
Vascular mortality	Death due to vascular cause	90 days and 1 year
Non-vascular mortality	Death due to non-vascular cause	90 days and 1 year
Myocardial infarction	Myocardial infarction	90 days and 1 year
Cardiac revascularization procedure	i.e., percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG] surgery	90 days and 1 year
New congestive heart failure	New congestive heart failure	90 days and 1 year
New clinically important atrial fibrillation	New clinically important atrial fibrillation	90 days
Nonfatal cardiac arrest	Nonfatal cardiac arrest	30 days and 1 year
Stroke	Stroke	90 days and 1 year
Peripheral arterial thrombosis	Peripheral arterial thrombosis	90 days and 1 year
Pulmonary embolism	Pulmonary embolism	90 days and 1 year
Deep venous thrombosis	Deep venous thrombosis	90 days and 1 year
Pneumonia	Pneumonia	90 days and 1 year
Sepsis	Sepsis	90 days and 1 year
Infection	Infection	90 days
Life-threatening bleeding	Life-threatening bleeding	90 days
Major bleeding	Major bleeding	90 days
New acute renal failure requiring dialysis	New acute renal failure requiring dialysis	90 days and 1 year
Peri-prosthetic fracture	Peri-prosthetic fracture	90 days and 1 year
Prosthetic hip dislocation	Prosthetic hip dislocation	90 days and 1 year
Implant failure	Implant failure	90 days and 1 year
Hip re-operation	Hip re-operation	30 days and 1 year
Time to first mobilization	Time to first mobilization	90 days
Length of critical care stay	Length of critical care stay	90 days
Length of rehabilitation stay	Length of rehabilitation stay	90 days
New residence in a nursing home	New residence in a nursing home	90 days and 1 year
Functional Independence Measure (FIM™)	Functional Independence Measure (FIM™)	30 days and 1 year
SF-36 score	SF-36 score	30 days and 1 year
Delirium within 7 days of randomization	Delirium within 7 days of randomization	7 days
Hospital readmission	Hospital readmission	90 days and 1 year
New pressure ulcers	New pressure ulcers	90 days
Incisional pain	Incisional pain	30 days
Chronic incisional pain	Chronic incisional pain	1 year
Acute Kidney Injury	Acute Kidney Injury	90 Day
Acute Kidney Injury	Acute Kidney Injury	1 Year
Mortality and Institutionalization status of dependents	Mortality and Institutionalization status of dependents	30 Days
Mortality and Institutionalization status of dependents	Mortality and Institutionalization status of dependents	1 Year
Economic Analysis	Economic Analysis	90 Days and 1 Year
Health System Utilization, Long Term Follow up	Health System Utilization, Long Term Follow up	2, 5, 10 Years

Collaborators and Investigators

• Sponsor: McMaster University
• Collaborators: Hamilton Health Sciences Corporation; Population Health Research Institute
• Investigators: Principal Investigator: Philip J Devereaux, MD, PhD, McMaster University; Principal Investigator: Mohit Bhandari, MD, PhD, McMaster University

Publications and helpful links

General Publications

• Borges FK, Devereaux PJ, Cuerden M, Bhandari M, Guerra-Farfan E, Patel A, Sigamani A, Umer M, Neary J, Tiboni M, Tandon V, Ramokgopa MT, Sancheti P, John B, Lawendy A, Balaguer-Castro M, Jenkinson R, Sleczka P, Nabi Nur A, Wood GCA, Feibel R, McMahon JS, Sigamani A, Biccard BM, Landoni G, Szczeklik W, Wang CY, Tomas-Hernandez J, Abraham V, Vincent J, Harvey V, Pettit S, Sontrop J, Garg AX; HIP ATTACK investigators. Effects of accelerated versus standard care surgery on the risk of acute kidney injury in patients with a hip fracture: a substudy protocol of the hip fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) international randomised controlled trial. BMJ Open. 2019 Sep 24;9(9):e033150. doi: 10.1136/bmjopen-2019-033150.
• Borges FK, Bhandari M, Patel A, Avram V, Guerra-Farfan E, Sigamani A, Umer M, Tiboni M, Adili A, Neary J, Tandon V, Sancheti PK, Lawendy A, Jenkinson R, Ramokgopa M, Biccard BM, Szczeklik W, Wang CY, Landoni G, Forget P, Popova E, Wood G, Nabi Nur A, John B, Sleczka P, Feibel RJ, Balaguer-Castro M, Deheshi B, Winemaker M, de Beer J, Kolesar R, Teixidor-Serra J, Tomas-Hernandez J, McGillion M, Shanthanna H, Moppett I, Vincent J, Pettit S, Harvey V, Gauthier L, Alvarado K, Devereaux PJ. 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 patients. BMJ Open. 2019 May 1;9(4):e028537. doi: 10.1136/bmjopen-2018-028537.
• HIP ATTACK Investigators. Accelerated surgery versus standard care in hip fracture (HIP ATTACK): an international, randomised, controlled trial. Lancet. 2020 Feb 29;395(10225):698-708. doi: 10.1016/S0140-6736(20)30058-1. Epub 2020 Feb 9. Erratum In: Lancet. 2021 Nov 27;398(10315):1964. Lancet. 2023 Apr 1;401(10382):1078.

Helpful Links

• HIP ATTACK Pilot Canadian Medical Association Journal (CMAJ) Publication

Study record dates

Study Major Dates

• Study Start (Actual): March 14, 2014
• Primary Completion (Actual): August 24, 2019
• Study Completion (Actual): September 30, 2022

Study Registration Dates

• First Submitted: January 2, 2014
• First Submitted That Met QC Criteria: January 2, 2014
• First Posted (Estimated): January 6, 2014

Study Record Updates

• Last Update Posted (Actual): January 22, 2024
• Last Update Submitted That Met QC Criteria: January 18, 2024
• Last Verified: January 1, 2024

More Information

Terms related to this study

• Keywords: Perioperative outcomes
• Additional Relevant MeSH Terms: Wounds and Injuries; Leg Injuries; Femoral Fractures; Hip Injuries; Fractures, Bone; Hip Fractures
• Other Study ID Numbers: HIP ATTACK Trial v5.0