Grant: Project Grant

Worldwide millions of adults (>35,000 Canadians) suffer a hip fracture every year. Hip fractures result in bleeding, inflammation, and stress states that can cause complications and death. There is evidence that early surgical treatment of a hip fracture may improve patients' outcomes, however, standard care in Canada is that most patients wait more than 24 hours to have surgery. Some patients may benefit more from the early surgery than others. Results from the HIP ATTACK-1 trial suggest that patients suffering heart injury (measured by a serum protein called troponin) at the time of a hip fracture have a higher risk of dying within 90 days. Standard care has been to medically manage these patients and postpone surgery; however, the HIP ATTACK-1 trial results suggested that hip fracture patients with heart injury had a lower risk of dying from early surgery as compared to standard care (i.e., surgery typically 24 hours later). Patients with a heart injury just after their hip fracture may reflect patients who are not tolerating the physiological stress of the fracture, and therefore accelerated surgery may reduce the time of heart injury and the risk of mortality. We plan to perform a new study (HIP ATTACK-2) to assess the impact of accelerated surgery (goal of surgery within 6 hours of diagnosis) versus usual timing of surgery on the 90-day risk of death in adults with a hip fracture that have elevated troponin levels after the fracture. We will randomize 1100 patients to receive accelerated surgery or standard care. We will include patients =45 years, with a hip fracture that requires surgery, and have elevated troponin levels on Emergency Room arrival. We will follow patients in hospital, and at 90 days after surgery. This trial will determine if a specific high-risk population should be prioritized with expedited surgical care. This is the first large trial that may change the paradigm to postpone surgery in patients suffering heart injuries before surgery.