Accelerated surgery versus standard care in hip fracture (HIP ATTACK): an international, randomised, controlled trial
Por:
Borges, FK, Bhandari, M, Guerra-Farfan, E, Patel, A, Sigamani, A, Umer, M, Tiboni, ME, Villar-Casares, MD, Tandon, V, Tomas-Hernandez, J, Teixidor-Serra, J, Avram, VRA, Winemaker, M, Ramokgopa, MT, Szczeklik, W, Landoni, G, Wang, CY, Begum, D, Neary, JD, Adili, A, Sancheti, PK, Lawendy, AR, Balaguer-Castro, M, Sleczka, P, Jenkinson, RJ, Nur, AN, Wood, GCA, Feibel, RJ, McMahon, SJ, Sigamani, A, Popova, E, Biccard, BM, Moppett, IK, Forget, P, Landais, P, McGillion, MH, Vincent, J, Balasubramanian, K, Harvey, V, Garcia-Sanchez, Y, Pettit, SM, Gauthier, LP, Guyatt, GH, Conen, D, Garg, AX, Bangdiwala, SI, Belley-Cote, EP, Marcucci, M, Lamy, A, Whitlock, R, Le Manach, Y, Fergusson, DA, Yusuf, S, Devereaux, PJ, Veevaete, L, de Waroux, BL, Lavand'homme, P, Cornu, O, Tribak, K, Yombi, JC, Touil, N, Reul, M, Bhutia, JT, Clinckaert, C, De Clippeleir, D, de Beer, J, Simpson, DL, Worster, A, Alvarado, KA, Gregus, KK, Lawrence, KH, Leong, DP, Joseph, PG, Magloire, P, Deheshi, B, Bisland, S, Wood, TJ, Tushinski, DM, Wilson, DAJ, Kearon, C, Cowan, DD, Khanna, V, Zaki, A, Farrell, JC, MacDonald, AM, Wong, SCW, Karbassi, A, Wright, DS, Shanthanna, H, Coughlin, R, Khan, M, Wikkerink, S, Quraishi, FA, Kishta, W, Schemitsch, E, Carey, T, Macleod, MD, Sanders, DW, Vasarhelyi, E, Bartley, D, Dresser, GK, Tieszer, C, Shadowitz, S, Lee, JS, Choi, S, Kreder, HJ, Nousiainen, M, Kunz, MR, Tuazon, R, Shrikumar, M, Ravi, B, Wasserstein, D, Stephen, DJG, Nam, D, Henry, PDG, Mann, SM, Jaeger, MT, Sivilotti, MLA, Smith, CA, Frank, CC, Grant, H, Ploeg, L, Yach, JD, Harrison, MM, Campbell, AR, Bicknell, RT, Bardana, DD, McIlquham, K, Gallant, C, Halman, S, Thiruganasambandamoorth, V, Ruggiero, S, Hadden, WJ, Chen, BPJ, Coupal, SA, McLean, LM, Shirali, HR, Haider, SY, Smith, CA, Watts, E, Santone, DJ, Koo, K, Yee, AJ, Oyenubi, AN, Nauth, A, Schemitsch, EH, Daniels, TR, Ward, SE, Hall, JA, Ahn, H, Whelan, DB, Atrey, A, Khoshbin, A, Puskas, D, Droll, K, Cullinan, C, Payendeh, J, Lefrancois, T, Mozzon, L, Marion, T, Jacka, MJ, Greene, J, Menon, M, Stiegelmahr, R, Dillane, D, Irwin, M, Beaupre, L, Coles, CP, Trask, K, MacDonald, S, Trenholm, JAI, Oxner, W, Richardson, CG, Dehghan, N, Sadoughi, M, Sharma, A, White, NJ, Olivieri, L, Hunt, SB, Turgeon, TR, Bohm, ER, Tran, S, Giilck, SM, Hupel, T, Guy, P, O'Brien, PJ, Duncan, AW, Crawford, GA, Zhou, JL, Zhao, YR, Liu, Y, Shan, L, Wu, AS, Munoz, JM, Chaudier, P, Douplat, M, Fessy, MH, Piriou, V, Louboutin, L, David, JS, Friggeri, A, Beroud, S, Fayet, JM, Leung, FKL, Fang, CX, Yee, DKH, Sancheti, PK, Pradhan, CV, Patil, AA, Puram, CP, Borate, MP, Kudrimoti, KB, Adhye, BA, Dongre, HV, John, B, Abraham, V, Pandey, RA, Rajkumar, A, George, PE, Stephen, M, Chandran, N, Ashraf, M, Georgekutty, AM, Sulthan, AS, Adinarayanan, S, Sharma, D, Barnawal, SP, Swaminathan, S, Bidkar, PU, Mishra, SK, Menon, J, Niranjan, M, Zachariah, KV, Hiremath, SA, Madhusudhan, NC, Jawali, A, Gnanadurai, KR, George, CE, Maddipati, T, Mary, KP, Sharma, V, Farooque, K, Malhotra, R, Mittal, S, Sawhney, C, Gupta, B, Mathur, P, Gamangati, S, Tripathy, V, Menon, PH, Dhillon, MS, Chouhan, DK, Patil, S, Narayan, R, Lal, P, Bilchod, PN, Singh, SU, Gattu, UV, Dashputra, RP, Rahate, PV, 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, HM, Lai, HY, Kumar, CS, Chee, KH, Loh, PS, Tan, KM, Singh, S, Foo, LL, Prakasam, K, Chaw, SH, Lee, ML, Ngim, JHL, Boon, HW, Chin, II, Kleinlugtenbelt, YV, Landman, EBM, Flikweert, ER, Roerdink, HW, Brokelman, RBG, Elskamp-Meijerman, HF, Horst, MR, Cobben, JHMG, Anjum, A, Hashmi, PM, Ahmed, T, Rashid, HU, Khattak, MJ, Rashid, RH, Lakdawala, RH, Noordin, S, Juman, NM, Khan, RI, Riaz, MM, Bokhari, SS, Almas, A, Wahab, H, Ali, A, Khan, HN, Khan, EK, Janjua, KA, Orakzai, SH, Khan, AS, Mustafa, KJ, Sohail, MA, Umar, M, Khan, SA, Ashraf, M, Khan, MK, Shiraz, M, Furgan, A, Dabek, P, Kumon, A, Satora, W, Ambrozy, W, Swiech, M, Rycombel, J, Grzelak, A, Gucwa, J, Machala, W, Ramokgopa, MT, Firth, GB, Karera, M, Fourtounas, M, Singh, V, Biscardi, A, Iqbal, MN, Campbell, RJ, Maluleke, ML, Moller, C, Nhlapo, L, Maqungo, S, Flint, M, Nejthardt, MB, Chetty, S, Naidoo, R, Clua, MG, Molero-Garcia, V, Minguell-Monyart, J, Marsa, JS, Porcel-Vazquez, JA, Andres-Peiro, JV, Aguilar, M, Mestre-Torres, J, Colomina, MJ, Guilabert, P, Gozalo, MLP, Abarca, L, Martin, N, Usua, G, Martinez-Ripol, P, Posada, MAG, Lalueza-Broto, P, Sanchez-Raya, J, Camarena, JN, 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, JL, Millan, A, Banos, V, Herrera-Mateo, S, Aguado, HJ, Martinez-Municio, G, Leon, R, Santiago-Maniega, S, Zabalza, A, Labrador, G, Guerado, E, Cruz, E, Cano, JR, Bogallo, JM, Sa-Ngasoongsong, P, Kulachote, N, Sirisreetreerux, N, Pengrung, N, Chalacheewa, T, Arnuntasupakul, V, Yingchoncharoen, T, Naratreekoon, B, Kadry, MA, Thayaparan, S, Abdlaziz, I, Aframian, A, Imbuldeniya, A, Bentoumi, S, Omran, S, Vizcaychipi, MP, Correia, P, Patil, S, Haire, K, Mayor, ASE, Dillingham, S, Nicholson, L, Elnaggar, M, John, J, Nanjayan, SK, Parker, MJ, O'Sullivan, S, Marmor, MT, Matityahu, A, McClellan, RT, Comstock, C, Ding, A, Toogood, P, Slobogean, G, Joseph, K, O'Toole, R, Sciadini, M, Ryan, SP, Clark, ME, Cassidy, C, Balonov, K, Bergese, SD, Phieffer, LS, Zacarias, AAG, Marcantonio, AJ, Dragic-Taylor, S, Maxwell, C, Molnar, S, Wells, JR, Ofori, SN, Yang, SS, Wang, MK, Duceppe, E, Spence, J, Vasquez, JP, Marcano-Fernandez, F, Ham, H, Prada, C, Yung, TCH, Perez, IS, Bosch, MJ, Prystajecky, MR, Chowdhury, C, Khan, JS, Stella, SF, Heidary, B, Tran, A, Wawrzycka-Adamczyk, K, Chen, YCP, Gonzalez-Osuna, A, Biedron, G, Wludarczyk, A, Lefebvre, M, Ernst, JA, Staffhorst, B, Woodfine, JD, Alwafi, EM, Mrkobrada, M, Parlow, S, Roberts, R, McAlister, F, Sackett, D, Wright, J
Publicada:
29 feb 2020
Resumen:
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; 1:0.40). 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. Copyright (C) 2020 Elsevier Ltd. All rights reserved.
Filiaciones:
Borges, FK:
McMaster Univ, Dept Med, Hamilton, ON, Canada
Populat Hlth Res Inst, Hamilton, ON, Canada
Bhandari, M:
McMaster Univ, Dept Surg, Hamilton, ON, Canada
Guerra-Farfan, E:
Vall Hebron Univ Hosp, Dept Orthoped Surg & Traumatol, Barcelona, Spain
Patel, A:
McMaster Univ, Dept Med, Hamilton, ON, Canada
Sigamani, A:
Narayana Hlth, Dept Clin Res, Bangalore, Karnataka, India
Govt TD Med Coll Hosp, Alappuzha, Kerala, India
Umer, M:
Aga Khan Univ, Dept Surg, Karachi, Pakistan
Tiboni, ME:
McMaster Univ, Dept Med, Hamilton, ON, Canada
Villar-Casares, MD:
Vall Hebron Univ Hosp, Dept Internal Med, Barcelona, Spain
Tandon, V:
McMaster Univ, Dept Med, Hamilton, ON, Canada
Tomas-Hernandez, J:
Vall Hebron Univ Hosp, Dept Orthoped Surg & Traumatol, Barcelona, Spain
Teixidor-Serra, J:
Vall Hebron Univ Hosp, Dept Orthoped Surg & Traumatol, Barcelona, Spain
Avram, VRA:
McMaster Univ, Dept Surg, Hamilton, ON, Canada
Winemaker, M:
McMaster Univ, Dept Surg, Hamilton, ON, Canada
Ramokgopa, MT:
Chris Hani Baragwanath Acad Hosp, Dept Orthopaed Surg, Johannesburg, South Africa
Univ Witwatersrand, Johannesburg, South Africa
Szczeklik, W:
Jagiellonian Univ, Dept Intens Care & Perioperat Med, Coll Med, Krakow, Poland
Landoni, G:
IRCCS San Raffaele Sci Inst, Dept Anaesthesia & Intens Care, Milan, Italy
Univ Vita Salute San Raffaele, Milan, Italy
Wang, CY:
Univ Malaya, Dept Anaesthesiol, Kuala Lumpur, Malaysia
Begum, D:
Aga Khan Univ, Karachi, Pakistan
Neary, JD:
McMaster Univ, Dept Med, Hamilton, ON, Canada
Adili, A:
McMaster Univ, Dept Surg, Hamilton, ON, Canada
Sancheti, PK:
Sancheti Inst Orthopaed & Rehabil, Dept Orthopaed, Pune, Maharashtra, India
Lawendy, AR:
Western Univ, Dept Surg, London Hlth Sci Ctr, London, ON, Canada
Balaguer-Castro, M:
Parc Tauli Hosp Univ, Dept Orthopaed Surg & Traumatol, Sabadell, Spain
Sleczka, P:
Samodzielny Publ Zaklad Opieki Zdrowotnej, Dept Orthopaed Surg, Myslenice, Poland
Jenkinson, RJ:
Univ Toronto, Dept Surg, Toronto, ON, Canada
Univ Toronto, Inst Hlth Policy Management & Evaluat, Toronto, ON, Canada
Nur, AN:
Shifa Int Hosp, Dept Orthopaed, Islamabad, Pakistan
Wood, GCA:
Queens Univ, Div Orthopaed, Kingston, ON, Canada
Feibel, RJ:
Ottawa Hosp, Div Orthopaed Surg, Ottawa, ON, Canada
McMahon, SJ:
Markham Stouffville Hosp, Dept Surg, Markham, ON, Canada
Sigamani, A:
Narayana Hlth, Dept Clin Res, Bangalore, Karnataka, India
Govt TD Med Coll Hosp, Alappuzha, Kerala, India
Popova, E:
Biomed Res Inst IIB St Pau, Barcelona, Spain
Biccard, BM:
Groote Schuur Hosp, Dept Anaesthesia & Perioperat Med, Cape Town, South Africa
Univ Cape Town, Cape Town, South Africa
Moppett, IK:
Univ Nottingham, Queens Med Ctr, Anaesthesia & Crit Care, Div Clin Neurosci, Nottingham, England
Forget, P:
Univ Aberdeen, Sch Med Med Sci & Nutr, Inst Appl Hlth Sci, Epidemiol Grp,Dept Anaesthesia,NHS Grampian, Aberdeen, Scotland
Landais, P:
Montpellier Univ, Dept Biostat & Clin Res, Montpellier, France
McGillion, MH:
Populat Hlth Res Inst, Hamilton, ON, Canada
McMaster Univ, Sch Nursing, Hamilton, ON, Canada
Vincent, J:
Populat Hlth Res Inst, Hamilton, ON, Canada
Balasubramanian, K:
Populat Hlth Res Inst, Hamilton, ON, Canada
Harvey, V:
Populat Hlth Res Inst, Hamilton, ON, Canada
Garcia-Sanchez, Y:
Vall Hebron Univ Hosp, Dept Orthoped Surg & Traumatol, Barcelona, Spain
Pettit, SM:
Populat Hlth Res Inst, Hamilton, ON, Canada
Gauthier, LP:
Juravinski Hosp, Hamilton Hlth Sci, Hamilton, ON, Canada
Guyatt, GH:
McMaster Univ, Dept Med, Hamilton, ON, Canada
McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada
Conen, D:
McMaster Univ, Dept Med, Hamilton, ON, Canada
Populat Hlth Res Inst, Hamilton, ON, Canada
McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada
Garg, AX:
McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada
Western Univ, Dept Med, London, ON, Canada
Bangdiwala, SI:
Populat Hlth Res Inst, Hamilton, ON, Canada
McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada
Belley-Cote, EP:
McMaster Univ, Dept Med, Hamilton, ON, Canada
Populat Hlth Res Inst, Hamilton, ON, Canada
Marcucci, M:
McMaster Univ, Dept Med, Hamilton, ON, Canada
Populat Hlth Res Inst, Hamilton, ON, Canada
McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada
Lamy, A:
Populat Hlth Res Inst, Hamilton, ON, Canada
McMaster Univ, Dept Surg, Hamilton, ON, Canada
McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada
Whitlock, R:
Populat Hlth Res Inst, Hamilton, ON, Canada
McMaster Univ, Dept Surg, Hamilton, ON, Canada
McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada
Le Manach, Y:
Populat Hlth Res Inst, Hamilton, ON, Canada
McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada
McMaster Univ, Dept Anaesthesiol, Hamilton, ON, Canada
Fergusson, DA:
Univ Ottawa, Ottawa Hosp, Res Inst, Clin Epidemiol Program, Ottawa, ON, Canada
Yusuf, S:
McMaster Univ, Dept Med, Hamilton, ON, Canada
Populat Hlth Res Inst, Hamilton, ON, Canada
McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada
Devereaux, PJ:
McMaster Univ, Dept Med, Hamilton, ON, Canada
Populat Hlth Res Inst, Hamilton, ON, Canada
McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada
Green Accepted, Green Submitted
|