Accelerated surgery versus standard care in hip fracture (HIP ATTACK): an international, randomised, controlled trial. Issue 10225 (29th February 2020)

• Record Type: Journal Article
• Authors: Borges, Flavia K; Bhandari, Mohit; Guerra-Farfan, Ernesto; Patel, Ameen; Sigamani, Alben; Umer, Masood; Tiboni, Maria E; Villar-Casares, Maria del Mar; Tandon, Vikas; Tomas-Hernandez, Jordi; Teixidor-Serra, Jordi; Avram, Victoria RA; Winemaker, Mitchell; Ramokgopa, Mmampapatla T; Szczeklik, Wojciech; Landoni, Giovanni; Wang, Chew Yin; Begum, Dilshad; Neary, John D; Adili, Anthony; Sancheti, Parag K; Lawendy, Abdel-Rahman; Balaguer-Castro, Mariano; Ślęczka, Paweł; Jenkinson, Richard J; Nur, Aamer Nabi; Wood, Gavin CA; Feibel, Robert J; McMahon, Stephen J; Sigamani, Alen; Popova, Ekaterine; Biccard, Bruce M; Moppett, Iain K; Forget, Patrice; Landais, Paul; McGillion, Michael H; Vincent, Jessica; Balasubramanian, Kumar; Harvey, Valerie; Garcia-Sanchez, Yaiza; Pettit, Shirley M; Gauthier, Leslie P; Guyatt, Gordon H; Conen, David; Garg, Amit X; Bangdiwala, Shrikant I; Belley-Cote, Emilie P; Marcucci, Maura; Lamy, Andre; Whitlock, Richard; Le Manach, Yannick; Fergusson, Dean A; Yusuf, Salim; Devereaux, PJ; Veevaete, Laurent; le Polain de Waroux, Bernard; Lavand'homme, Patricia; Cornu, Olivier; Tribak, Karim; Yombi, Jean Cyr; Touil, Nassim; Reul, Maike; Bhutia, Jigme Tshering; Clinckaert, Carol; De Clippeleir, Dirk; Reul, Maike; Patel, Ameen; Tandon, Vikas; Gauthier, Leslie P; Avram, Victoria RA; Winemaker, Mitchell; de Beer, Justin; Simpson, Diane L; Worster, Andrew; Alvarado, Kim A; Gregus, Krysten K; Lawrence, Kelly H; Leong, Darryl P; Joseph, Philip G; Magloire, Patrick; Deheshi, Benjamin; Bisland, Stuart; Wood, Thomas J; Tushinski, Daniel M; Wilson, David AJ; Kearon, Clive; Le Manach, Yannick; Adili, Anthony; Tiboni, Maria E; Neary, John D; Cowan, David D; Khanna, Vickas; Zaki, Amna; Farrell, Janet C; MacDonald, Anne Marie; Conen, David; Wong, Steven CW; Karbassi, Arsha; Wright, Douglas Steven; Shanthanna, Harsha; Coughlin, Ryan; Khan, Moin; Wikkerink, Spencer; Quraishi, Faraaz A; Lawendy, Abdel-Rahman; Kishta, Waleed; Schemitsch, Emil; Carey, Timothy; Macleod, Mark D; Sanders, David W; Vasarhelyi, Edward; Bartley, Debra; Dresser, George K; Tieszer, Christina; Jenkinson, Richard J; Shadowitz, Steven; Lee, Jacques S; Choi, Stephen; Kreder, Hans J; Nousiainen, Markku; Kunz, Monica R; Tuazon, Ravianne; Shrikumar, Mopina; Ravi, Bheeshma; Wasserstein, David; Stephen, David JG; Nam, Diane; Henry, Patrick DG; Wood, Gavin CA; Mann, Stephen M; Jaeger, Melanie T; Sivilotti, Marco LA; Smith, Christopher A; Frank, Christopher C; Grant, Heather; Ploeg, Leone; Yach, Jeff D; Harrison, Mark M; Campbell, Aaron R; Bicknell, Ryan T; Bardana, Davide D; Feibel, Robert J; McIlquham, Katie; Gallant, Catherine; Halman, Samantha; Thiruganasambandamoorth, Venkatesh; Ruggiero, Sara; Hadden, William J; Chen, Brian P-J; Coupal, Stephanie A; McMahon, Stephen J; McLean, Lisa M; Shirali, Hemant R; Haider, Syed Y; Smith, Crystal A; Watts, Evan; Santone, David J; Koo, Kevin; Yee, Allan J; Oyenubi, Ademilola N; Nauth, Aaron; Schemitsch, Emil H; Daniels, Timothy R; Ward, Sarah E; Hall, Jeremy A; Ahn, Henry; Whelan, Daniel B; Atrey, Amit; Khoshbin, Amir; Puskas, David; Droll, Kurt; Cullinan, Claude; Payendeh, Jubin; Lefrancois, Tina; Mozzon, Lise; Marion, Travis; Jacka, Michael J; Greene, James; Menon, Matthew; Stiegelmahr, Robert; Dillane, Derek; Irwin, Marleen; Beaupre, Lauren; Coles, Chad P; Trask, Kelly; MacDonald, Shelley; Trenholm, J Andrew I; Oxner, William; Richardson, C Glen; Dehghan, Niloofar; Sadoughi, Mehdi; Sharma, Achal; White, Neil J; Olivieri, Loretta; Hunt, Stephen B; Turgeon, Thomas R; Bohm, Eric R; Tran, Sarah; Giilck, Stephen M; Hupel, Tom; Guy, Pierre; O'Brien, Peter J; Duncan, Andrew W; Crawford, Gordon A; Zhou, Junlin; Zhao, Yanrui; Liu, Yang; Shan, Lei; Wu, Anshi; Muñoz, Juan Manuel; Chaudier, Philippe; Douplat, Marion; Fessy, Michel Henri; Piriou, Vincent; Louboutin, Lucie; David, Jean Stephane; Friggeri, Arnaud; Beroud, Sebastien; Fayet, Jean Marie; Landais, Paul; Leung, Frankie Ka Li; Fang, Christian Xinshuo; Yee, Dennis King Hang; Sancheti, Parag Kantilal; Pradhan, Chetan Vijay; Patil, Atul Ashok; Puram, Chetan Prabhakar; Borate, Madhav Pandurang; Kudrimoti, Kiran Bhalchandra; Adhye, Bharati Anil; Dongre, Himanshu Vijaykumar; John, Bobby; Abraham, Valsamma; Pandey, Ritesh Arvind; Rajkumar, Arti; George, Preetha Elizabeth; Sigamani, Alen; Stephen, Manesh; Chandran, Nitheesh; Ashraf, Mohammed; Georgekutty, AM; Sulthan, Ahamad Shaheel; Adinarayanan, S; Sharma, Deep; Barnawal, Satish Prasad; Swaminathan, Srinivasan; Bidkar, Prasanna Udupi; Mishra, Sandeep Kumar; Menon, Jagdish; M, Niranjan; K, Varghese Zachariah; Hiremath, Santosh Angad; NC, Madhusudhan; Jawali, Abhijit; Gnanadurai, Kingsly Robert; George, Carolin Elizabeth; Maddipati, Tatarao; KP, Mary KP; Sharma, Vijay; Farooque, Kamran; Malhotra, Rajesh; Mittal, Samarth; Sawhney, Chavi; Gupta, Babita; Mathur, Purva; Gamangati, Shivanand; Tripathy, Vijaylaxmi; Menon, Prem Haridas; Dhillon, Mandeep S; Chouhan, Devendra K; Patil, Sharanu; Narayan, Ravi; Lal, Purushotham; Bilchod, Prashanth Nabhirajappa; Singh, Surya Udai; Gattu, Uttam Vaidya; Dashputra, Ravi Prabhakar; Rahate, Prashant Vitthal; Turiel, Maurizio; De Blasio, Giuseppe; Accetta, Riccardo; Perazzo, Paolo; Stella, Daniele; Bonadies, Marika; Colombo, Chiara; Fozzato, Stefania; Pino, Fabio; Morelli, Ilaria; Colnaghi, Eleonora; Salini, Vincenzo; Denaro, Giuseppe; Beretta, Luigi; Placella, Giacomo; Giardina, Giuseppe; Binda, Mirko; Marcato, Anna; Guzzetti, Luca; Piccirillo, Fabio; Cecconi, Maurizio; Khor, HM; Lai, Hou Yee; Kumar, CS; Chee, KH; Loh, PS; Tan, Kit Mun; Singh, Simmrat; Foo, Li Lian; Prakasam, Komella; Chaw, Sook Hui; Lee, Meng-Li; Ngim, Joanne HL; Boon, Huck Wee; Chin, Im Im; Kleinlugtenbelt, Ydo V; Landman, Ellie BM; Flikweert, Elvira R; Roerdink, Herbert W; Brokelman, Roy B.G.; Elskamp-Meijerman, Hannie F; Horst, Maarten R; Cobben, Jan-Hein MG; Umer, Masood; Begum, Dilshad; Anjum, Anila; Hashmi, Pervaiz Mehmood; Ahmed, Tashfeen; Rashid, Haroon Ur; Khattak, Mujahid Jamil; Rashid, Rizwan Haroon; Lakdawala, Riaz Hussain; Noordin, Shahryar; Juman, Naveed Muhammed; Khan, Robyna Irshad; Riaz, Muhammad Mehmood; Bokhari, Syedah Saira; Almas, Ayesha; Wahab, Hussain; Ali, Arif; Khan, Hammad Naqi; Khan, Eraj Khurshid; Nur, Aamer Nabi; Janjua, Kholood Abid; Orakzai, Sajjad Hassan; Khan, Abdus Salam; Mustafa, Khawaja Junaid; Sohail, Mian Amjad; Umar, Muhammad; Khan, Siddra Ahmed; Ashraf, Muhammad; Khan, Muhammad Kashif; Shiraz, Muhammad; Furgan, Ahmad; Ślęczka, Paweł; Dąbek, Piotr; Kumoń, Adam; Satora, Wojciech; Ambroży, Wojciech; Święch, Mariusz; Rycombel, Jacek; Grzelak, Adrian; Gucwa, Jaroslaw; Machala, Waldemar; Ramokgopa, Mmampapatla Thomas; Firth, Gregory Bodley; Karera, Mwalimu; Fourtounas, Maria; Singh, Virsen; Biscardi, Anna; Iqbal, Muhammad Nasir; Campbell, Ryan Jonathan; Maluleke, Matimba Lenny; Moller, Carien; Nhlapo, Lerato; Maqungo, Sithombo; Flint, Margot; Nejthardt, Marcin B; Chetty, Sean; Naidoo, Rubendren; Guerra-Farfan, Ernesto; Tomas-Hernandez, Jordi; Garcia-Sanchez, Yaiza; Garrido Clua, Miriam; Molero-Garcia, Vicente; Minguell-Monyart, Joan; Teixidor-Serra, Jordi; Villar-Casares, Maria del Mar; Selga Marsa, Jordi; Porcel-Vazquez, Juan A; Andres-Peiro, Jose-Vicente; Aguilar, Marc; Mestre-Torres, Jaume; Colomina, Maria J; Guilabert, Patricia; Paños Gozalo, M Luisa; Abarca, Luis; Martin, Nuria; Usua, Gemma; Martinez-Ripol, Pedro; Gonzalez Posada, MA; Lalueza-Broto, Pilar; Sanchez-Raya, Judith; Nuñez Camarena, Jorge; Fraguas-Castany, Antoni; Balaguer-Castro, Mariano; Torner, Pere; Jornet-Gibert, Monsant; Serrano-Sanz, Jorge; Cámara-Cabrera, Jaume; Salomó-Domènech, Mònica; Yela-Verdú, Christian; Peig-Font, Anna; Ricol, Laura; Carreras-Castañer, Anna; Martínez-Sañudo, Luis; Herranz, Susana; Feijoo-Massó, Carlos; Sianes-Gallén, Mònica; Castillón, Pablo; Bernaus, Martí; Quintas, Saioa; Gómez, Olga; Salvador, Jordi; Abarca, Javiera; Estrada, Cristina; Novellas, Marga; Torra, Mercè; Dealbert, Alfred; Macho, Oscar; Ivanov, Alexia; Valldosera, Esther; Arroyo, Marta; Pey, Borja; Yuste, Antoni; Mateo, Llorenç; De Caso, Julio; Anaya, Rafael; Higa-Sansone, JL; Millan, Angelica; Baños, Victoria; Herrera-Mateo, Sergio; Aguado, Hector J; Martinez-Municio, Gonzalo; León, Ricardo; Santiago-Maniega, Silvia; Zabalza, Ana; Labrador, Gregorio; Guerado, Enrique; Cruz, Encarnacion; Cano, Juan Ramon; Bogallo, Jose Manuel; Sa-ngasoongsong, Paphon; Kulachote, Noratep; Sirisreetreerux, Norachart; Pengrung, Nachapan; Chalacheewa, Theerawat; Arnuntasupakul, Vanlapa; Yingchoncharoen, Teerapat; Naratreekoon, Bundit; Kadry, Miriam Adel; Thayaparan, Surendini; Abdlaziz, Ihab; Aframian, Arash; Imbuldeniya, Arjuna; Bentoumi, Souad; Omran, Sherif; Vizcaychipi, Marcela Paola; Correia, Patricia; Patil, Shashank; Haire, Kevin; Mayor, Amy SE; Dillingham, Sally; Nicholson, Laura; Elnaggar, Mohamed; John, Joby; Nanjayan, Shashi Kumar; Parker, Martyn J; O'Sullivan, Susan; Marmor, Meir T; Matityahu, Amir; McClellan, Robert Trigg; Comstock, Curt; Ding, Anthony; Toogood, Paul; Slobogean, Gerard; Joseph, Katherine; O'Toole, Robert; Sciadini, Marcus; Ryan, Scott P; Clark, Molly E; Cassidy, Charles; Balonov, Konstantin; Bergese, Sergio D; Phieffer, Laura S; Gonzalez Zacarias, Alicia A; Marcantonio, Andrew J; Devereaux, PJ; Bhandari, Mohit; Borges, Flavia K; Balasubramanian, Kumar; Bangdiwala, Shrikant I; Harvey, Valerie; McGillion, Michael H; Pettit, Shirley M; Vincent, Jessica; Vincent, Jessica; Harvey, Valerie; Dragic-Taylor, Sanela; Maxwell, Chelsea; Molnar, Sarah; Pettit, Shirley M; Wells, Jennifer R; Forget, Patrice; Borges, Flavia K; Landais, Paul; Sigamani, Alben; Landoni, Giovanni; Wang, Chew Yin; Szczeklik, Wojciech; Biccard, Bruce M; Popova, Ekaterine; Moppett, Iain K; Lamy, Andre; Whitlock, Richard; Ofori, Sandra N; Yang, Stephen S; Wang, Michael K; Duceppe, Emmanuelle; Spence, Jessica; Vasquez, Javiera P; Marcano-Fernández, Francesc; Conen, David; Ham, Hyungjoo; Tiboni, Maria E; Prada, Carlos; Yung, Terence CH; Sanz Pérez, Isidro; Neary, John D; Bosch, Michael J; Prystajecky, Michael R; Chowdhury, Chinmoy; Khan, James S; Belley-Cote, Emilie P; Stella, Steffan F; Marcucci, Maura; Heidary, Behrouz; Tran, Allen; Wawrzycka-Adamczyk, Katarzyna; Chen, Yu Chiao Peter; Tandon, Vikas; González-Osuna, Aránzazu; Patel, Ameen; Biedroń, Grzegorz; Wludarczyk, Anna; Lefebvre, Marco; Ernst, Jaclyn A; Staffhorst, Bas; Woodfine, Jason D; Alwafi, Emad M; Mrkobrada, Marko; Parlow, Simon; Roberts, Robin; McAlister, Finlay; Sackett, David; Wright, James;
• Is Part Of: Lancet. Volume 395:Issue 10225(2020)
• Page Start: 698
• Page End: 708
• Publication Date: 2020-02-29
• Subjects: Medicine -- Periodicals; Medicine -- Periodicals; Medicine; Medicine; Electronic journals; Periodicals; 610.5
• DOI: 10.1016/S0140-6736(20)30058-1
• Languages: English
• ISSNs: 0140-6736

Abstract

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.