HIP ATTACK

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

HIP ATTACK Investigators. Lancet (London, England) 2020 · PMID 32050090 · doi:10.1016/s0140-6736(20)30058-1

Question

Does accelerated surgery within hours of diagnosis reduce mortality and major complications compared with standard timing in hip fracture?

Design

International multicentre RCT across many countries.

Patients

Adults aged 45 or over with a hip fracture requiring surgery.

Intervention

Accelerated surgery (target within 6 hours of diagnosis)

Comparison

Standard care timing

Primary outcome

Co-primary outcomes of mortality and major perioperative complications at 90 days

Key result

Accelerated surgery did not significantly reduce either mortality or the composite of major complications at 90 days. Some secondary outcomes, such as delirium and time to mobilisation, favoured accelerated surgery.

Limitations

Standard care in many participating sites was already relatively fast, and it was not possible to blind patients or clinicians.

Impact on practice

Supports the UK standard of surgery on the day of or day after admission rather than ultra-early surgery, while confirming that unnecessary delay should still be avoided.