Speaker: Reduced urinary, delirium issues are among benefits of early hip fracture surgery
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PHOENIX — At the Orthopaedic Research Society Annual Meeting, here, investigator and cardiologist Philip J. Devereaux, MD, said accelerated surgery that occurred within 6 hours of a low-energy hip fracture was not associated with any lower risk of mortality or any fewer major complications than standard hip fracture care, which involved surgery performed 24 hours after the fracture.
The international, randomized controlled trial that was presented, which is called Hip Attack, included multiple investigators at 69 centers in 17 countries and 2,970 patients aged 45 years old or older.
In the patients assigned to accelerated surgery, the mortality rate was 9.3% (139 patients) and in patients assigned to standard of care, the mortality rate was 10.4% (154 patients).
Investigators looked at several subgroups in their analysis of the findings. In the subgroup of 90-day major complications, they found “patients randomized to accelerated surgery who had an elevated troponin, 21% of them had a major complication within 90 days. In contrast, in the standard care group, 34% of these patients had a major complication,” Devereaux said.
“The result is highly statistically significant favoring better outcome, again, in the accelerated surgery group,” he said.
“Our conclusions: Among patients with hip fractures, accelerated surgery did not significantly lower the risk of mortality or a composite of major complications. However, accelerated surgery showed no evidence of harm, even in subjects with acute medical conditions when they presented to the hospital. Accelerated surgery did demonstrate a lower risk of delirium, urinary tract infections and moderate to severe pain scores on days 4 to 7 after surgery,” Devereaux said.
It is likely that less delirium occurred in the accelerated surgery group because those patients mobilized faster, had fewer urinary tract infections and they experienced less pain overall compared to the standard care group, he said. – by Susan M. Rapp
References:
Devereaux PJ. Paper 181A. Presented at: Orthopaedic Research Society Annual Meeting; Feb. 8-11, 2020; Phoenix.
Disclosure: Devereaux reports the study was funded by the Canadian Institutes of Health Research. He reports he receives research support from Abbott, Philips, Roche and Siemens.