Early surgery for hip fractures in older people may substantially improve outcomes for patients, according to the results from a randomized controlled trial in CMAJ (Canadian Medical Association Journal).
Hip fractures can cause serious complications that may result in death or admission to long-term care facilities for some older adults who previously lived at home. Hip fractures cause pain, bleeding and immobility, which can lead to medical complications in people awaiting surgery.
In many countries, including Canada, waits for hip surgery can be 24 hours or longer, mainly because of preoperative medical clearance procedures and operating room access. To determine whether early surgery improves outcomes for people with hip fractures, a team of Canadian researchers enrolled 60 people aged 45 years or older who were diagnosed with a hip fracture requiring surgery on a weekday during daytime working hours. The patients, from 2 hospitals in Hamilton, Ontario, Canada and 1 in Pune, India, were randomized to a group that received accelerated care (30 patients) and to a control group that received standard care (30 patients).
The mean age of participants was 81 years, and 63% were female. Many had several illnesses, of whom 68% had hypertension, 20% coronary artery disease and 17% dementia. For patients in the accelerated care group, the median time between diagnosis with fracture and clearance for surgery was 1.5 hours compared with 3.4 hours in the standard care group. The median time from diagnosis to surgery was 6 hours for the accelerated care group, more than 18 hours less than the 24.2 hours to surgery in the standard care group.
The researchers set a target of 6 hours for accelerated surgery. "We believe that the shortest time possible will provide the greatest potential for benefit, as is the case in acute myocardial infarction and stroke," states Dr. P.J. Devereaux, McMaster University, Hamilton, Ontario, Canada, co-principal investigator of the HIP ATTACK pilot trial.
"This pilot trial shows demonstrates the feasibility of a trial comparing accelerated and standard care among patients with a hip fracture," conclude the authors. "The results provide encouraging evidence that accelerated surgery may substantially improve outcomes in these patients," states Dr. Mohit Bhandari, McMaster University, co-principal investigator of the HIP ATTACK pilot trial.
The research team plans to conduct a full-scale trial in 2014 and invites interested researchers to join the trial.