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Accelerated surgery improves outcomes in patients with hip fracture
Compared to standard care, accelerated surgery may substantially improve outcomes in patients with hip fracture.
In their pilot study, researchers randomly assigned patients aged 45 years or older who had a hip fracture that required surgery during weekday, daytime working hours to receive either accelerated or standard care. Feasibility outcomes included the proportion of eligible patients randomly assigned, completeness of follow-up and timelines of accelerated surgery. Main clinical outcomes included major perioperative complications within 30 days of randomization assessed by data collectors and adjudicators who were unaware of study group allocations.
All patients completed 30-day follow-up. Compared with a median time from diagnosis to surgery of 24.2 hours in the standard care group, researchers found a median time from diagnosis to surgery of 6 hours in the accelerated care group. According to study results, 30% of patients in the accelerated care group experienced a major perioperative complication vs. 47% of patients in the standard care group.
Based on these results, the researchers have designed a full trial to determine whether accelerated surgical care prevents major perioperative complications.
Disclosure: Mohit Bhandari, MD, PhD, received consultancy fees or grants from Smith & Nephew, Stryker, Amgen, Zimmer, Moximed, Bioventus, DePuy and Eli Lilly. Mark Crowther received grants or personal fees from Octapharma and CSL Behring. John Eikelboom, MBBS, MSc, received honoraria or grants from Boehringer Ingelheim, Bristol-Myers Squibb, Pfizer, Bayer and Daiichi Sankyo. PJ Devereaux, MD, PhD, received grants from Abbott Diagnostics, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Covidien, Stryker and Roche Diagnostics, and participated in an advisory board meeting for GlaxoSmithKline and an expert panel meeting for AstraZeneca.