Hip Fracture? Get to the OR ASAP

The speed of surgery after a hip fracture may have a significant impact on outcomes for older patients, and faster may be better, say researchers at McMaster University. Their study, which involved 60 people aged 45 or older, was just published in the Canadian Medical Association Journal (CMAJ).

Of the participants, who hailed from Canada and India, half received accelerated surgery within six hours and half had standard care of surgery 24 hours after diagnosis with a hip fracture. Among patients receiving standard care, 47% suffered a major complication of death, heart attack, stroke, pneumonia, blood clot or major bleeding event. However, only 30% of the patients in the accelerated surgery group suffered one of these complications.

“We believe that the shortest time possible to treatment may provide the greatest potential for benefit, as is the case in acute heart attack and stroke, ” said Dr. P.J. Devereaux in the November 18, 2013 news release. Dr. Devereaux is an associate professor of medicine and epidemiology at the Michael G. DeGroote School of Medicine at McMaster and co-principal investigator of the pilot trial.

Dr. Mohit Bhandari, a professor of surgery at the McMaster medical school and co-principal investigator, added: “This pilot provides encouraging evidence that accelerated surgery may substantially improve outcomes in these patients.”

Dr. Bhandari told OTW, “It has long been perceived that patients with hip fractures should have surgery delayed until they can be ‘medically optimized’ for an operative procedure. These wait times can sometimes result in several day delays while cardiovascular indices are optimized for surgery. Using these approaches, however, have not decreased perioperative mortality from hip fractures over the past 30 years—suggesting that other issues may be at play.”

“Our previous meta-analysis (CMAJ, Simunovic et al.) suggested a trend towards improved post-surgical survival with earlier surgery. This led us to design a trial focused on robustly testing the impact of accelerated surgery on major cardiovascular outcomes. Heart attacks and strokes are both serious events that have been dramatically impacted by early interventions. There is no reason to believe that hip fractures are no less important, and equally impacted by rapid intervention. Our pilot RCT seems to suggest we are right. We are launching the pivotal trial to include centers around the world.”