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-Farfán, Ernesto (Universitat Autònoma de Barcelona. Departament de Medicina)
Kessler Borges, Flavia (Department of Medicine, McMaster University (Canadà))
Bhandari, Mohit (McMaster University (Canadà))
Garcia-Sanchez, Yaiza (Vall d'Hebron Institut de Recerca (VHIR))
Nuoez, Jorge H. (Hospital Universitari MútuaTerrassa (Terrassa, Catalunya))
Mestre Torres, Jaume (Hospital Universitari Vall d'Hebron)
Tomas-Hernandez, Jordi (Hospital Universitari Vall d'Hebron)
Teixidor Serra, Jordi (Hospital Universitari Vall d'Hebron)
Balaguer Castro, Mariano (Hospital Clínic i Provincial de Barcelona)
Castillón-Bernal, Pablo (Hospital Universitari MútuaTerrassa (Terrassa, Catalunya))
Dealbert, Alfred (Consorci Sanitari del Garraf)
De Caso, Julio (Institut de Recerca Sant Pau)
Aguado, Héctor J. (Hospital Clínico Universitario de Valladolid)
Guerado, Enrique (Hospital Universitario Costal Del Sol)
Popova, Ekaterine (Institut de Recerca Sant Pau)
Tonelli, Ana Claudia (Hospital de Clínicas de Porto Alegre (Brasil))
Balasubramanian, Kumar (Population Health Research Institute (Canadà))
Vincent, Jessica (Population Health Research Institute (Canadà))
Harvey, Valerie (Population Health Research Institute (Canadà))
Kocaqi, Etri (McMaster University (Canadà))
Slobogean, Gerard (University of Maryland)
Devereaux, P. J. (Population Health Research Institute (Canadà))

Data:	2024
Resum:	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.
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Llengua:	Anglès
Document:	Article ; recerca ; Versió acceptada per publicar
Matèria:	Hip fracture ; Surgical Procedure ; Accelerated ; Mortality ; Perioperative Complications ; Surgical Timelines ; Medical Outcomes
Publicat a:	Injury, Vol. 55 Núm. 11 (november 2024) , p. 111827, ISSN 1879-0267

DOI: 10.1016/j.injury.2024.111827

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