Mortality, perioperative complications and surgical timelines in hip fracture patients: Comparison of the Spanish with the non-Spanish Cohort of the HIP ATTACK-1 trial

Guerra-Farfan E 1 , Borges FK 2 , Bhandari M 3 , Garcia-Sanchez Y 4 , Nuoez JH 5 , Mestre-Torres J 6 Show all authors , Tomas-Hernandez J 7 , Teixidor-Serra J 7 , Balaguer-Castro M 8 , Castillon P 9 , Dealbert A 10 , De Caso Rodriguez J 11 , Aguado HJ 12 , Guerado E 13 , Popova E 11 , Tonelli AC 14 , Balasubramanian K 15 , Vincent J 15 , Harvey V 15 , Kocaqi E 16 , Slobogean G 17 , Devereaux PJ 18 , Hip Attack-1 Investigators

Affiliations 

  • 1 Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departament de Cirurgia, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Orthopaedic Surgery and Traumatology, Artro-Esport, Centro Médico Teknon, Barcelona, Spain
  • 2 Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
  • 3 Department of Surgery, McMaster University, Hamilton, Ontario, Canada
  • 4 Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain. Electronic address: yaiza.garcia@vhir.org
  • 5 Department of Orthopaedic Surgery and Traumatology, Artro-Esport, Centro Médico Teknon, Barcelona, Spain; Department of Orthopaedic Surgery and Traumatology, University Hospital of Mutua de Terrassa, Terrassa, Barcelona, Spain
  • 6 Department of Medicine, Hospital Universitari Vall d'Hebron, Barcelona, Spain
  • 7 Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
  • 8 Department of Orthopaedic Surgery and Traumatology, Parc Taulí Hospital Universitari, Sabadell, Barcelona, Spain; Department of Orthopaedic Surgery and Traumatology, Hospital Clínic Barcelona, Barcelona, Spain
  • 9 Department of Orthopaedic Surgery and Traumatology, University Hospital of Mutua de Terrassa, Terrassa, Barcelona, Spain
  • 10 Department of Orthopaedic Surgery and Traumatology, Consorci Sanitari Del Garraf, Barcelona, Spain
  • 11 Biomedical Research Institute, (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona Spain
  • 12 Department of Orthopaedic Surgery and Traumatology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
  • 13 Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Costal Del Sol, Medical School. University of Málaga, Marbella, Málaga, Spain
  • 14 Internal Medicine Service, Hospital de Clinicas de Porto Alegre (HCPA), Brazil
  • 15 Population Health Research Institute, Hamilton, Ontario, Canada
  • 16 Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
  • 17 R Adams Cowley Shock Trauma (STC) at the University of Maryland Medical Center's Division of Orthopaedic Traumatology, Baltimore, US
  • 18 Population Health Research Institute, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
Injury, 2024 Aug 20;55(11):111827.
PMID: 39217648 DOI: 10.1016/j.injury.2024.111827

Abstract

BACKGROUND: Hip fractures carry a substantial risk of complications and death. This study aimed to report the 90-day incidence of mortality, major perioperative complications and in-hospital timelines after a hip fracture in the Spanish HIP ATTACK-1 trial cohort, comparing with the non-Spanish cohort.

METHODS: Prospective cohort study of Spanish patients nested in the HIP ATTACK-1 trial. The HIP ATTACK-1 was an international, randomized, controlled trial (17 countries, 69 hospitals, 7 in Spain, highest recruiting country). Patients were randomized to either accelerated surgery (goal of surgery within 6 h of diagnosis) or standard care. Participants were ≥45 years of age who presented with a low-energy hip fracture requiring surgery.

RESULTS: Among 534 patients in the Spanish cohort, 69 (12.9 %) patients died at 90 days follow-up, compared to 225 (9.2 %) in the non-Spanish cohort (p = 0.009), mostly due to higher nonvascular related mortality. A composite of major postoperative complication occurred in 126 patients (23.6 %). The most common perioperative complications were myocardial injury (189 patients, 35.4 %), infection with no sepsis (86 patients, 16.1 %) and perioperative delirium (84 patients, 15.7 %); all these complication rates in Spain were significantly higher than the non-Spanish patients (29.2 % p = 0.005; 11.9 % p = 0.008 and 9.2 % p < 0.0001, respectively). Spanish cohort patients were older and had more comorbidities than the non-Spanish cohort, evidencing their greater frailty at baseline. Among Spanish patients, the median time from hip fracture diagnosis to surgery was 30.0 h (IQR 21.1-53.9) in the standard-care group, with 68.8 % of patients receiving surgery within 48 h of diagnosis. This median time was lower in the non-Spanish cohort (22.8 h, IQR 9.5-37.0), where 82.1 % of patients were operated within 48 h.

CONCLUSIONS: In the HIP ATTACK-1 trial, 1 in 8 patients died 90 days after a hip fracture in Spain. The most common complication after a hip fracture was myocardial injury, followed by infection and delirium. Spanish patients had worse outcomes than non-Spanish patients. Research needs to focus on new interventions such as accelerated surgery and perioperative troponin measurement with the appropriate investment of resources, to prevent and identify early these complications with a goal of improving mortality for this high-risk population.

LEVEL OF EVIDENCE: II.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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