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

Borges, F.K.; Bhandari, M.; Guerra-Farfan, E.; Patel, A.; Sigamani, A.; Umer, M.; Tiboni, M.E.; Villar-Casares, M.D.M.; Tandon, V.; Tomas-Hernandez, J.; Teixidor-Serra, J.; Avram, V.R.; Winemaker, M.; Ramokgopa, M.T.; Szczeklik, W.; Landoni, G.; Wang, C.Y.; Begum, D.; Neary, J.D.; Adili, A.; Sancheti, P.K.; Lawendy, A.-.; Balaguer-Castro, M.; Sleczka, P.; Jenkinson, R.J.; Nur, A.N.; Wood, G.C.; Feibel, R.J.; Mcmahon, S.J.; Sigamani, A.; Popova, E.; Biccard, B.M.; Moppett, I.K.; Forget, P.; Landais, P.; Mcgillion, M.H.; Vincent, J.; Balasubramanian, K.; Harvey, V.; Garcia-Sanchez, Y.; Pettit, S.M.; Gauthier, L.P.; Guyatt, G.H.; Conen, D.; Garg, A.X.; Bangdiwala, S.I.; Belley-Cote, E.P.; Marcucci, M.; Lamy, A.; Whitlock, R.; Le Manach, Y.; Fergusson, D.A.; Yusuf, S.; Devereaux, P.J.; Veevaete, L.; le Polain de Waroux, B.; Lavand'Homme, P.; Cornu, O.; Tribak, K.; Yombi, J.C.; Touil, N.; Reul, M.; Bhutia, J.T.; Clinckaert, C.; De Clippeleir, D.; de Beer, J.; Simpson, D.L.; Worster, A.; Alvarado, K.A.; Gregus, K.K.; Lawrence, K.H.; Leong, D.P.; Joseph, P.G.; Magloire, P.; Deheshi, B.; Bisland, S.; Wood, T.J.; Tushinski, D.M.; Wilson, D.A.; Kearon, C.; Cowan, D.D.; Khanna, V.; Zaki, A.; Farrell, J.C.; Macdonald, A.M.; Wong, S.C.; Karbassi, A.; Wright, D.S.; Shanthanna, H.; Coughlin, R.; Khan, M.; Wikkerink, S.; Quraishi, F.A.; Kishta, W.; Schemitsch, E.; Carey, T.; Macleod, M.D.; Sanders, D.W.; Vasarhelyi, E.; Bartley, D.; Dresser, G.K.; Tieszer, C.; Shadowitz, S.; Lee, J.S.; Choi, S.; Kreder, H.J.; Nousiainen, M.; Kunz, M.R.; Tuazon, R.; Shrikumar, M.; Ravi, B.; Wasserstein, D.; Stephen, D.J.; Nam, D.; Henry, P.D.; Mann, S.M.; Jaeger, M.T.; Sivilotti, M.L.; Smith, C.A.; Frank, C.C.; Grant, H.; Ploeg, L.; Yach, J.D.; Harrison, M.M.; Campbell, A.R.; Bicknell, R.T.; Bardana, D.D.; Mcilquham, K.; Gallant, C.; Halman, S.; Thiruganasambandamoorth, V.; Ruggiero, S.; Hadden, W.J.; Chen, B.P.-.; Coupal, S.A.; Mclean, L.M.; Shirali, H.R.; Haider, S.Y.; Smith, C.A.; Watts, E.; Santone, D.J.; Koo, K.; Yee, A.J.; Oyenubi, A.N.; Nauth, A.; Schemitsch, E.H.; Daniels, T.R.; Ward, S.E.; Hall, J.A.; Ahn, H.; Whelan, D.B.; Atrey, A.; Khoshbin, A.; Puskas, D.; Droll, K.; Cullinan, C.; Payendeh, J.; Lefrancois, T.; Mozzon, L.; Marion, T.; Jacka, M.J.; Greene, J.; Menon, M.; Stiegelmahr, R.; Dillane, D.; Irwin, M.; Beaupre, L.; Coles, C.P.; Trask, K.; Macdonald, S.; Trenholm, J.A.I.; Oxner, W.; Richardson, C.G.; Dehghan, N.; Sadoughi, M.; Sharma, A.; White, N.J.; Olivieri, L.; Hunt, S.B.; Turgeon, T.R.; Bohm, E.R.; Tran, S.; Giilck, S.M.; Hupel, T.; Guy, P.; O'Brien, P.J.; Duncan, A.W.; Crawford, G.A.; Zhou, J.; Zhao, Y.; Liu, Y.; Shan, L.; Wu, A.; Munoz, J.M.; Chaudier, P.; Douplat, M.; Fessy, M.H.; Piriou, V.; Louboutin, L.; David, J.S.; Friggeri, A.; Beroud, S.; Fayet, J.M.; Leung, F.K.L.; Fang, C.X.; Yee, D.K.H.; Sancheti, P.K.; Pradhan, C.V.; Patil, A.A.; Puram, C.P.; Borate, M.P.; Kudrimoti, K.B.; Adhye, B.A.; Dongre, H.V.; John, B.; Abraham, V.; Pandey, R.A.; Rajkumar, A.; George, P.E.; Stephen, M.; Chandran, N.; Ashraf, M.; Georgekutty, A.M.; Sulthan, A.S.; Adinarayanan, S.; Sharma, D.; Barnawal, S.P.; Swaminathan, S.; Bidkar, P.U.; Mishra, S.K.; Menon, J.; N. K V. Z., M.; Hiremath, S.A.; Nc, M.; Jawali, A.; Gnanadurai, K.R.; George, C.E.; Maddipati, T.; M. K., K.; Sharma, V.; Farooque, K.; Malhotra, R.; Mittal, S.; Sawhney, C.; Gupta, B.; Mathur, P.; Gamangati, S.; Tripathy, V.; Menon, P.H.; Dhillon, M.S.; Chouhan, D.K.; Patil, S.; Narayan, R.; Lal, P.; Bilchod, P.N.; Singh, S.U.; Gattu, U.V.; Dashputra, R.P.; Rahate, P.V.; Turiel, M.; De Blasio, G.; Accetta, R.; Perazzo, P.; Stella, D.; Bonadies, M.; Colombo, C.; Fozzato, S.; Pino, F.; Morelli, I.; Colnaghi, E.; Salini, V.; Denaro, G.; Beretta, L.; Placella, G.; Giardina, G.; Binda, M.; Marcato, A.; Guzzetti, L.; Piccirillo, F.; Cecconi, M.; Khor, H.M.; Lai, H.Y.; Kumar, C.S.; Chee, K.H.; Loh, P.S.; Tan, K.M.; Singh, S.; Foo, L.L.; Prakasam, K.; Chaw, S.H.; Lee, M.-.; Ngim, J.H.; Boon, H.W.; Chin, I.I.; Kleinlugtenbelt, Y.V.; Landman, E.B.; Flikweert, E.R.; Roerdink, H.W.; Brokelman, R.B.G.; Elskamp-Meijerman, H.F.; Horst, M.R.; Cobben, J.-.M.; Anjum, A.; Hashmi, P.M.; Ahmed, T.; Rashid, H.U.; Khattak, M.J.; Rashid, R.H.; Lakdawala, R.H.; Noordin, S.; Juman, N.M.; Khan, R.I.; Riaz, M.M.; Bokhari, S.S.; Almas, A.; Wahab, H.; Ali, A.; Khan, H.N.; Khan, E.K.; Janjua, K.A.; Orakzai, S.H.; Khan, A.S.; Mustafa, K.J.; Sohail, M.A.; Umar, M.; Khan, S.A.; Ashraf, M.; Khan, M.K.; Shiraz, M.; Furgan, A.; Dabek, P.; Kumon, A.; Satora, W.; Ambrozy, W.; Swiech, M.; Rycombel, J.; Grzelak, A.; Gucwa, J.; Machala, W.; Ramokgopa, M.T.; Firth, G.B.; Karera, M.; Fourtounas, M.; Singh, V.; Biscardi, A.; Iqbal, M.N.; Campbell, R.J.; Maluleke, M.L.; Moller, C.; Nhlapo, L.; Maqungo, S.; Flint, M.; Nejthardt, M.B.; Chetty, S.; Naidoo, R.; Garrido Clua, M.; Molero-Garcia, V.; Minguell-Monyart, J.; Selga Marsa, J.; Porcel-Vazquez, J.A.; Andres-Peiro, J.-.; Aguilar, M.; Mestre-Torres, J.; Colomina, M.J.; Guilabert, P.; Panos Gozalo, M.L.; Abarca, L.; Martin, N.; Usua, G.; Martinez-Ripol, P.; Gonzalez Posada, M.A.; Lalueza-Broto, P.; Sanchez-Raya, J.; Nunez Camarena, J.; Fraguas-Castany, A.; Torner, P.; Jornet-Gibert, M.; Serrano-Sanz, J.; Camara-Cabrera, J.; Salomo-Domenech, M.; Yela-Verdu, C.; Peig-Font, A.; Ricol, L.; Carreras-Castaner, A.; Martinez-Sanudo, L.; Herranz, S.; Feijoo-Masso, C.; Sianes-Gallen, M.; Castillon, P.; Bernaus, M.; Quintas, S.; Gomez, O.; Salvador, J.; Abarca, J.; Estrada, C.; Novellas, M.; Torra, M.; Dealbert, A.; Macho, O.; Ivanov, A.; Valldosera, E.; Arroyo, M.; Pey, B.; Yuste, A.; Mateo, L.; De Caso, J.; Anaya, R.; Higa-Sansone, J.L.; Millan, A.; Banos, V.; Herrera-Mateo, S.; Aguado, H.J.; Martinez-Municio, G.; Leon, R.; Santiago-Maniega, S.; Zabalza, A.; Labrador, G.; Guerado, E.; Cruz, E.; Cano, J.R.; Bogallo, J.M.; Sa-ngasoongsong, P.; Kulachote, N.; Sirisreetreerux, N.; Pengrung, N.; Chalacheewa, T.; Arnuntasupakul, V.; Yingchoncharoen, T.; Naratreekoon, B.; Kadry, M.A.; Thayaparan, S.; Abdlaziz, I.; Aframian, A.; Imbuldeniya, A.; Bentoumi, S.; Omran, S.; Vizcaychipi, M.P.; Correia, P.; Patil, S.; Haire, K.; Mayor, A.S.; Dillingham, S.; Nicholson, L.; Elnaggar, M.; John, J.; Nanjayan, S.K.; Parker, M.J.; O'Sullivan, S.; Marmor, M.T.; Matityahu, A.; Mcclellan, R.T.; Comstock, C.; Ding, A.; Toogood, P.; Slobogean, G.; Joseph, K.; O'Toole, R.; Sciadini, M.; Ryan, S.P.; Clark, M.E.; Cassidy, C.; Balonov, K.; Bergese, S.D.; Phieffer, L.S.; Gonzalez Zacarias, A.A.; Marcantonio, A.J.; Dragic-Taylor, S.; Maxwell, C.; Molnar, S.; Wells, J.R.; Ofori, S.N.; Yang, S.S.; Wang, M.K.; Duceppe, E.; Spence, J.; Vasquez, J.P.; Marcano-Fernandez, F.; Ham, H.; Prada, C.; Yung, T.C.; Sanz Perez, I.; Bosch, M.J.; Prystajecky, M.R.; Chowdhury, C.; Khan, J.S.; Stella, S.F.; Heidary, B.; Tran, A.; Wawrzycka-Adamczyk, K.; Chen, Y.C.P.; Gonzalez-Osuna, A.; Biedron, G.; Wludarczyk, A.; Lefebvre, M.; Ernst, J.A.; Staffhorst, B.; Woodfine, J.D.; Alwafi, E.M.; Mrkobrada, M.; Parlow, S.; Roberts, R.; Mcalister, F.; Sackett, D.; Wright, J.

doi:10.1016/S0140-6736(20)30058-1

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.

Accelerated surgery versus standard care in hip fracture (HIP ATTACK) : an international, randomised, controlled trial / F.K. Borges, M. Bhandari, E. Guerra-Farfan, A. Patel, A. Sigamani, M. Umer, M.E. Tiboni, M.D.M. Villar-Casares, V. Tandon, J. Tomas-Hernandez, J. Teixidor-Serra, V.R. Avram, M. Winemaker, M.T. Ramokgopa, W. Szczeklik, G. Landoni, C.Y. Wang, D. Begum, J.D. Neary, A. Adili, P.K. Sancheti, A.-. Lawendy, M. Balaguer-Castro, P. Sleczka, R.J. Jenkinson, A.N. Nur, G.C. Wood, R.J. Feibel, S.J. McMahon, A. Sigamani, E. Popova, B.M. Biccard, I.K. Moppett, P. Forget, P. Landais, M.H. McGillion, J. Vincent, K. Balasubramanian, V. Harvey, Y. Garcia-Sanchez, S.M. Pettit, L.P. Gauthier, G.H. Guyatt, D. Conen, A.X. Garg, S.I. Bangdiwala, E.P. Belley-Cote, M. Marcucci, A. Lamy, R. Whitlock, Y. Le Manach, D.A. Fergusson, S. Yusuf, P.J. Devereaux, L. Veevaete, B. le Polain de Waroux, P. Lavand'homme, O. Cornu, K. Tribak, J.C. Yombi, N. Touil, M. Reul, J.T. Bhutia, C. Clinckaert, D. De Clippeleir, J. de Beer, D.L. Simpson, A. Worster, K.A. Alvarado, K.K. Gregus, K.H. Lawrence, D.P. Leong, P.G. Joseph, P. Magloire, B. Deheshi, S. Bisland, T.J. Wood, D.M. Tushinski, D.A. Wilson, C. Kearon, D.D. Cowan, V. Khanna, A. Zaki, J.C. Farrell, A.M. MacDonald, S.C. Wong, A. Karbassi, D.S. Wright, H. Shanthanna, R. Coughlin, M. Khan, S. Wikkerink, F.A. Quraishi, W. Kishta, E. Schemitsch, T. Carey, M.D. Macleod, D.W. Sanders, E. Vasarhelyi, D. Bartley, G.K. Dresser, C. Tieszer, S. Shadowitz, J.S. Lee, S. Choi, H.J. Kreder, M. Nousiainen, M.R. Kunz, R. Tuazon, M. Shrikumar, B. Ravi, D. Wasserstein, D.J. Stephen, D. Nam, P.D. Henry, S.M. Mann, M.T. Jaeger, M.L. Sivilotti, C.A. Smith, C.C. Frank, H. Grant, L. Ploeg, J.D. Yach, M.M. Harrison, A.R. Campbell, R.T. Bicknell, D.D. Bardana, K. McIlquham, C. Gallant, S. Halman, V. Thiruganasambandamoorth, S. Ruggiero, W.J. Hadden, B.P.-. Chen, S.A. Coupal, L.M. McLean, H.R. Shirali, S.Y. Haider, C.A. Smith, E. Watts, D.J. Santone, K. Koo, A.J. Yee, A.N. Oyenubi, A. Nauth, E.H. Schemitsch, T.R. Daniels, S.E. Ward, J.A. Hall, H. Ahn, D.B. Whelan, A. Atrey, A. Khoshbin, D. Puskas, K. Droll, C. Cullinan, J. Payendeh, T. Lefrancois, L. Mozzon, T. Marion, M.J. Jacka, J. Greene, M. Menon, R. Stiegelmahr, D. Dillane, M. Irwin, L. Beaupre, C.P. Coles, K. Trask, S. MacDonald, J.A.I. Trenholm, W. Oxner, C.G. Richardson, N. Dehghan, M. Sadoughi, A. Sharma, N.J. White, L. Olivieri, S.B. Hunt, T.R. Turgeon, E.R. Bohm, S. Tran, S.M. Giilck, T. Hupel, P. Guy, P.J. O'Brien, A.W. Duncan, G.A. Crawford, J. Zhou, Y. Zhao, Y. Liu, L. Shan, A. Wu, J.M. Munoz, P. Chaudier, M. Douplat, M.H. Fessy, V. Piriou, L. Louboutin, J.S. David, A. Friggeri, S. Beroud, J.M. Fayet, F.K.L. Leung, C.X. Fang, D.K.H. Yee, P.K. Sancheti, C.V. Pradhan, A.A. Patil, C.P. Puram, M.P. Borate, K.B. Kudrimoti, B.A. Adhye, H.V. Dongre, B. John, V. Abraham, R.A. Pandey, A. Rajkumar, P.E. George, M. Stephen, N. Chandran, M. Ashraf, A.M. Georgekutty, A.S. Sulthan, S. Adinarayanan, D. Sharma, S.P. Barnawal, S. Swaminathan, P.U. Bidkar, S.K. Mishra, J. Menon, N.K.V.Z. M, S.A. Hiremath, M. Nc, A. Jawali, K.R. Gnanadurai, C.E. George, T. Maddipati, M.K. Kp, V. Sharma, K. Farooque, R. Malhotra, S. Mittal, C. Sawhney, B. Gupta, P. Mathur, S. Gamangati, V. Tripathy, P.H. Menon, M.S. Dhillon, D.K. Chouhan, S. Patil, R. Narayan, P. Lal, P.N. Bilchod, S.U. Singh, U.V. Gattu, R.P. Dashputra, P.V. Rahate, M. Turiel, G. De Blasio, R. Accetta, P. Perazzo, D. Stella, M. Bonadies, C. Colombo, S. Fozzato, F. Pino, I. Morelli, E. Colnaghi, V. Salini, G. Denaro, L. Beretta, G. Placella, G. Giardina, M. Binda, A. Marcato, L. Guzzetti, F. Piccirillo, M. Cecconi, H.M. Khor, H.Y. Lai, C.S. Kumar, K.H. Chee, P.S. Loh, K.M. Tan, S. Singh, L.L. Foo, K. Prakasam, S.H. Chaw, M.-. Lee, J.H. Ngim, H.W. Boon, I.I. Chin, Y.V. Kleinlugtenbelt, E.B. Landman, E.R. Flikweert, H.W. Roerdink, R.B.G. Brokelman, H.F. Elskamp-Meijerman, M.R. Horst, J.-.M. Cobben, A. Anjum, P.M. Hashmi, T. Ahmed, H.U. Rashid, M.J. Khattak, R.H. Rashid, R.H. Lakdawala, S. Noordin, N.M. Juman, R.I. Khan, M.M. Riaz, S.S. Bokhari, A. Almas, H. Wahab, A. Ali, H.N. Khan, E.K. Khan, K.A. Janjua, S.H. Orakzai, A.S. Khan, K.J. Mustafa, M.A. Sohail, M. Umar, S.A. Khan, M. Ashraf, M.K. Khan, M. Shiraz, A. Furgan, P. Dabek, A. Kumon, W. Satora, W. Ambrozy, M. Swiech, J. Rycombel, A. Grzelak, J. Gucwa, W. Machala, M.T. Ramokgopa, G.B. Firth, M. Karera, M. Fourtounas, V. Singh, A. Biscardi, M.N. Iqbal, R.J. Campbell, M.L. Maluleke, C. Moller, L. Nhlapo, S. Maqungo, M. Flint, M.B. Nejthardt, S. Chetty, R. Naidoo, M. Garrido Clua, V. Molero-Garcia, J. Minguell-Monyart, J. Selga Marsa, J.A. Porcel-Vazquez, J.-. Andres-Peiro, M. Aguilar, J. Mestre-Torres, M.J. Colomina, P. Guilabert, M.L. Panos Gozalo, L. Abarca, N. Martin, G. Usua, P. Martinez-Ripol, M.A. Gonzalez Posada, P. Lalueza-Broto, J. Sanchez-Raya, J. Nunez Camarena, A. Fraguas-Castany, P. Torner, M. Jornet-Gibert, J. Serrano-Sanz, J. Camara-Cabrera, M. Salomo-Domenech, C. Yela-Verdu, A. Peig-Font, L. Ricol, A. Carreras-Castaner, L. Martinez-Sanudo, S. Herranz, C. Feijoo-Masso, M. Sianes-Gallen, P. Castillon, M. Bernaus, S. Quintas, O. Gomez, J. Salvador, J. Abarca, C. Estrada, M. Novellas, M. Torra, A. Dealbert, O. Macho, A. Ivanov, E. Valldosera, M. Arroyo, B. Pey, A. Yuste, L. Mateo, J. De Caso, R. Anaya, J.L. Higa-Sansone, A. Millan, V. Banos, S. Herrera-Mateo, H.J. Aguado, G. Martinez-Municio, R. Leon, S. Santiago-Maniega, A. Zabalza, G. Labrador, E. Guerado, E. Cruz, J.R. Cano, J.M. Bogallo, P. Sa-ngasoongsong, N. Kulachote, N. Sirisreetreerux, N. Pengrung, T. Chalacheewa, V. Arnuntasupakul, T. Yingchoncharoen, B. Naratreekoon, M.A. Kadry, S. Thayaparan, I. Abdlaziz, A. Aframian, A. Imbuldeniya, S. Bentoumi, S. Omran, M.P. Vizcaychipi, P. Correia, S. Patil, K. Haire, A.S. Mayor, S. Dillingham, L. Nicholson, M. Elnaggar, J. John, S.K. Nanjayan, M.J. Parker, S. O'Sullivan, M.T. Marmor, A. Matityahu, R.T. McClellan, C. Comstock, A. Ding, P. Toogood, G. Slobogean, K. Joseph, R. O'Toole, M. Sciadini, S.P. Ryan, M.E. Clark, C. Cassidy, K. Balonov, S.D. Bergese, L.S. Phieffer, A.A. Gonzalez Zacarias, A.J. Marcantonio, S. Dragic-Taylor, C. Maxwell, S. Molnar, J.R. Wells, S.N. Ofori, S.S. Yang, M.K. Wang, E. Duceppe, J. Spence, J.P. Vasquez, F. Marcano-Fernandez, H. Ham, C. Prada, T.C. Yung, I. Sanz Perez, M.J. Bosch, M.R. Prystajecky, C. Chowdhury, J.S. Khan, S.F. Stella, B. Heidary, A. Tran, K. Wawrzycka-Adamczyk, Y.C.P. Chen, A. Gonzalez-Osuna, G. Biedron, A. Wludarczyk, M. Lefebvre, J.A. Ernst, B. Staffhorst, J.D. Woodfine, E.M. Alwafi, M. Mrkobrada, S. Parlow, R. Roberts, F. McAlister, D. Sackett, J. Wright. - In: THE LANCET. - ISSN 0140-6736. - 395:10225(2020 Feb 29), pp. 698-708. [10.1016/S0140-6736(20)30058-1]

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

Borges F. K.;Bhandari M.;Guerra-Farfan E.;Patel A.;Sigamani A.;Umer M.;Tiboni M. E.;Villar-Casares M. D. M.;Tandon V.;Tomas-Hernandez J.;Teixidor-Serra J.;Avram V. R.;Winemaker M.;Ramokgopa M. T.;Szczeklik W.;Landoni G.;Wang C. Y.;Begum D.;Neary J. D.;Adili A.;Sancheti P. K.;Lawendy A. -R.;Balaguer-Castro M.;Sleczka P.;Jenkinson R. J.;Nur A. N.;Wood G. C.;Feibel R. J.;McMahon S. J.;Sigamani A.;Popova E.;Biccard B. M.;Moppett I. K.;Forget P.;Landais P.;McGillion M. H.;Vincent J.;Balasubramanian K.;Harvey V.;Garcia-Sanchez Y.;Pettit S. M.;Gauthier L. P.;Guyatt G. H.;Conen D.;Garg A. X.;Bangdiwala S. I.;Belley-Cote E. P.;Marcucci M.;Lamy A.;Whitlock R.;Le Manach Y.;Fergusson D. A.;Yusuf S.;Devereaux P. J.;Veevaete L.;le Polain de Waroux B.;Lavand'homme P.;Cornu O.;Tribak K.;Yombi J. C.;Touil N.;Reul M.;Bhutia J. T.;Clinckaert C.;De Clippeleir D.;de Beer J.;Simpson D. L.;Worster A.;Alvarado K. A.;Gregus K. K.;Lawrence K. H.;Leong D. P.;Joseph P. G.;Magloire P.;Deheshi B.;Bisland S.;Wood T. J.;Tushinski D. M.;Wilson D. A.;Kearon C.;Cowan D. D.;Khanna V.;Zaki A.;Farrell J. C.;MacDonald A. M.;Wong S. C.;Karbassi A.;Wright D. S.;Shanthanna H.;Coughlin R.;Khan M.;Wikkerink S.;Quraishi F. A.;Kishta W.;Schemitsch E.;Carey T.;Macleod M. D.;Sanders D. W.;Vasarhelyi E.;Bartley D.;Dresser G. K.;Tieszer C.;Shadowitz S.;Lee J. S.;Choi S.;Kreder H. J.;Nousiainen M.;Kunz M. R.;Tuazon R.;Shrikumar M.;Ravi B.;Wasserstein D.;Stephen D. J.;Nam D.;Henry P. D.;Mann S. M.;Jaeger M. T.;Sivilotti M. L.;Smith C. A.;Frank C. C.;Grant H.;Ploeg L.;Yach J. D.;Harrison M. M.;Campbell A. R.;Bicknell R. T.;Bardana D. D.;McIlquham K.;Gallant C.;Halman S.;Thiruganasambandamoorth V.;Ruggiero S.;Hadden W. J.;Chen B. P. -J.;Coupal S. A.;McLean L. M.;Shirali H. R.;Haider S. Y.;Smith C. A.;Watts E.;Santone D. J.;Koo K.;Yee A. J.;Oyenubi A. N.;Nauth A.;Schemitsch E. H.;Daniels T. R.;Ward S. E.;Hall J. A.;Ahn H.;Whelan D. 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2020

Abstract

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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	Parole chiave
	
			accelerated surgery; adult; aged; Article; bleeding; cerebrovascular accident; controlled study; female; hazard ratio; heart infarction; hip fracture; hip hemiarthroplasty; hip surgery; human; major clinical study; male; middle aged; mortality; multicenter study; open reduction (procedure); osteosynthesis; outcome assessment; pneumonia; priority journal; randomized controlled trial; risk reduction; sepsis; total hip replacement; venous thromboembolism; cardiovascular disease; clinical trial; comorbidity; comparative study; daily life activity; delirium; dementia; demography; diabetes mellitus; early intervention; femoral neck fracture; heart muscle ischemia; hemiarthroplasty; hip fracture; hip replacement; international cooperation; nursing home; open fracture reduction; postoperative complication; postoperative hemorrhage; procedures; proportional hazards model; sepsis; time to treatment; treatment outcome; very elderly
		
	Settori scientifico-disciplinari dell'articolo
	
			Settore MED/33 - Malattie Apparato Locomotore
Settore MED/09 - Medicina Interna
Settore MED/11 - Malattie dell'Apparato Cardiovascolare
		
	Data di pubblicazione
	
			29-feb-2020
		
	Data ahead of print o data di stampa
	
			9-feb-2020
		
	Rivista in ANCE
	
			THE LANCET
		
	DOI
	
			https://dx.doi.org/10.1016/S0140-6736(20)30058-1
		
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/784742

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