Accelerated care versus standard care among patients with hip fracture: the HIP ATTACK pilot trial
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چکیده
E52 CMAJ, January 7, 2014, 186(1) © 2014 Canadian Medical Association or its licensors Annually in North America, 0.8% of women and 0.4% of men aged 65 years or older experience a hip fracture. Patients who sustain a hip fracture face a high risk of serious complications (i.e., cardiovascular, venous thrombotic, infectious and hemorrhagic) that can result in a prolonged hospital stay and death: 30-day mortality is 9% among men and 5% among women. Among surviving patients who were community-dwelling before their fracture, 11% become bed-ridden and 16% are admitted to a long-term care facility. A hip fracture results in pain, bleeding and immobility. These factors initiate inflammatory, hypercoagulable, catabolic and stress states that can precipitate medical complications. Early surgery shortens the exposure to these harmful states and, therefore, may reduce morbidity and mortality. Furthermore, earlier surgery may shorten the period of immobility, which may improve functional outcomes and reduce costs. A meta-analysis of observational studies evaluating the timing of surgery for a hip fracture included 5 studies (involving 4208 patients and 721 deaths) that reported the adjusted risk of mortality. Earlier surgery, irrespective of the cut-off for delay (24, 48 or 72 h), was associated with significantly lower mortality (adjusted relative risk 0.81, 95% confidence interval [CI] 0.68–0.96, p = 0.01). Although these data are encouraging, the apparent benefit may be a result of residual confounding (e.g., sicker patients may have had surgery delayed for medical optimization, which may not have been adequately adjusted for in the analyses). Conversely, the real potential of early surgery may be underestimated because the greatest impact may occur when a hip fracture is treated much more quickly than the timelines assessed in the observational studies (24, 48 or 72 h), similar to how treatment of an acute myocardial infarction or stroke within hours has the most dramatic impact. In many countries, including Canada, most patients with a hip fracture wait longer than Accelerated care versus standard care among patients with hip fracture: the HIP ATTACK pilot trial
منابع مشابه
Accelerated care versus standard care among patients with hip fracture: the HIP ATTACK pilot trial.
BACKGROUND A hip fracture causes bleeding, pain and immobility, and initiates inflammatory, hypercoagulable, catabolic and stress states. Accelerated surgery may improve outcomes by reducing the duration of these states and immobility. We undertook a pilot trial to determine the feasibility of a trial comparing accelerated care (i.e., rapid medical clearance and surgery) and standard care among...
متن کاملAccelerated care versus standard care among patients with hip fracture: the HIP ATTACK pilot trial
women and 0.4% of men aged 65 years or older experience a hip fracture. Patients who sustain a hip fracture face a high risk of serious complications (i.e., cardiovascular, venous thrombotic, infectious and hemorrhagic) that can result in a prolonged hospital stay and death: 30-day mortality is 9% among men and 5% among women. Among surviving patients who were community-dwelling before their fr...
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Each year, millions of adults worldwide suffer a hip fracture [1,2]. Hip fractures primarily occur in the elderly and have devastating consequences. A hip fracture initiates inflammatory, hypercoagulable, stress and catabolic states that can cause medical complications (e.g., myocardial infarction, pulmonary embolism, pneumonia, sepsis, stroke and life-threatening and major bleeding) [3,4]. The...
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INTRODUCTION Pertrochanteric hip fractures occur in an elderly population and cause considerable morbidity and loss of functional ability as the fracture heals. Recently, parathyroid hormone (PTH), which is licensed for the treatment of osteoporosis, has been shown to potentially accelerate bone healing in animal and human studies. If its administration could allow a faster functional recovery ...
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