Accelerated care versus standard care among patients with hip fracture: the HIP ATTACK pilot trial
Hip Fracture Accelerated Surgical Treatment and Care Track (HIP ATTACK) Investigators, Giovanna Lurati Buse, Mohit Bhandari, Parag Sancheti, Steve Rocha, Mitchell Winemaker, Anthony Adili, Justin de Beer, Maria Tiboni, John D D Neary, Valerie Dunlop, Leslie Gauthier, Ameen Patel, Andrea Robinson, Reitze N Rodseth, Rick Kolesar, Janet Farrell, Mark Crowther, Vikas Tandon, Patrick Magloire, Hisham Dokainish, Philip Joseph, Charles W Tomlinson, Omid Salehian, Debbie Hastings, Dereck L Hunt, Harriette Van Spall, Tammy L Cosman, Diane L Simpson, David Cowan, Gordon Guyatt, Kim Alvarado, W K Bill Evans, Ryszard Mizera, John Eikelboom, Deborah Cook, Mark Loeb, Jennie Johnstone, Clive Kearon, Daniel I Sessler, Thomas VanHelder, Purnima Rao-Melacini, Andrew Worster, Atul Patil, Richard McLean, Anne-Marie Macdonald, Rick Badzioch, P J Devereaux, Hip Fracture Accelerated Surgical Treatment and Care Track (HIP ATTACK) Investigators, Giovanna Lurati Buse, Mohit Bhandari, Parag Sancheti, Steve Rocha, Mitchell Winemaker, Anthony Adili, Justin de Beer, Maria Tiboni, John D D Neary, Valerie Dunlop, Leslie Gauthier, Ameen Patel, Andrea Robinson, Reitze N Rodseth, Rick Kolesar, Janet Farrell, Mark Crowther, Vikas Tandon, Patrick Magloire, Hisham Dokainish, Philip Joseph, Charles W Tomlinson, Omid Salehian, Debbie Hastings, Dereck L Hunt, Harriette Van Spall, Tammy L Cosman, Diane L Simpson, David Cowan, Gordon Guyatt, Kim Alvarado, W K Bill Evans, Ryszard Mizera, John Eikelboom, Deborah Cook, Mark Loeb, Jennie Johnstone, Clive Kearon, Daniel I Sessler, Thomas VanHelder, Purnima Rao-Melacini, Andrew Worster, Atul Patil, Richard McLean, Anne-Marie Macdonald, Rick Badzioch, P J Devereaux
Abstract
Background: A hip fracture causes bleeding, pain and immobility, and initiates inflammatory, hypercoagulable, catabolic and stress states. Accelerated surgery may improve outcomes by reducing the duration of these states and immobility. We undertook a pilot trial to determine the feasibility of a trial comparing accelerated care (i.e., rapid medical clearance and surgery) and standard care among patients with a hip fracture.
Methods: Patients aged 45 years or older who, during weekday, daytime working hours, received a diagnosis of a hip fracture requiring surgery were randomly assigned to receive accelerated or standard care. Our feasibility outcomes included the proportion of eligible patients randomly assigned, completeness of follow-up and timelines of accelerated surgery. The main clinical outcome, assessed by data collectors and adjudicators who were unaware of study group allocations, was a major perioperative complication (i.e., a composite of death, preoperative myocardial infarction, myocardial injury after noncardiac surgery, pulmonary embolism, pneumonia, stroke, and life-threatening or major bleeding) within 30 days of randomization.
Results: Of 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 centre in India. All patients completed 30-day follow-up. The median time from diagnosis to surgery was 6.0 hours in the accelerated care group and 24.2 hours in the standard care group (p < 0.001). A major perioperative complication occurred in 9 (30%) of the patients in the accelerated care group and 14 (47%) of the patients in the standard care group (hazard ratio 0.60, 95% confidence interval 0.26-1.39).
Interpretation: These results show the feasibility of a trial comparing accelerated and standard care among patients with hip fracture and support a definitive trial.
Trial registration: ClinicalTrials.gov, no. NCT01344343.
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Source: PubMed