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

Issued Date

2024-11-01

Resource Type

Article

ISSN

00201383

eISSN

18790267

DOI

10.1016/j.injury.2024.111827

Scopus ID

2-s2.0-85202737282

Journal Title

Injury

Volume

55

Issue

11

Rights Holder(s)

SCOPUS

Bibliographic Citation

Injury Vol.55 No.11 (2024)

Suggested Citation

Guerra-Farfan E., Borges F.K., Bhandari M., Garcia-Sanchez Y., Nuoez J.H., Mestre-Torres J., Tomas-Hernandez J., Teixidor-Serra J., Balaguer-Castro M., Castillon P., Dealbert A., De Caso Rodriguez J., Aguado H.J., Guerado E., Popova E., Tonelli A.C., Balasubramanian K., Vincent J., Harvey V., Kocaqi E., Slobogean G., Devereaux P.J., Veevaete L., Waroux B.l.P.d., Lavand'homme P., Cornu O., Tribak K., Yombi J.C., Touil N., Bhutia J.T., Clinckaert C., Clippeleir D.D., Reul M., Patel A., Tandon V., Gauthier L.P., Avram V.R.A., Winemaker M., de Beer J., Simpson D.L., Worster A., Alvarado K.A., Gregus K.K., Lawrence K.H., Leong D.P., Joseph P.G., Magloire P., Deheshi B., Bisland S., Wood T.J., Tushinski D.M., Wilson D.A.J., Haider S., Bali K., Kearon C., Manach Y.L., Adili A., Tiboni M.E., Neary J.D., Cowan D.D., Khanna V., Zaki A., Farrell J.C., MacDonald A.M., Conen D., Wong S.C.W., Karbassi A., Wright D.S., Shanthanna H., Coughlin R., Khan M., Wikkerink S., Quraishi F.A., Lawendy A.R., Kishta W., Schemitsch E., Carey T., Macleod M.D., Sanders D.W., Vasarhelyi E., Bartley D., Dresser G.K., Tieszer C., Jenkinson R.J., Shadowitz S., Lee J.S., Choi S., Kreder H.J., Nousiainen M., Kunz M.R., Tuazon R., Shrikumar M., Ravi B., Wasserstein D., Stephen D.J.G., Nam D., Henry P.D.G., Wood G.C.A., Mann S.M., Jaeger M.T. 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. Injury Vol.55 No.11 (2024). doi:10.1016/j.injury.2024.111827 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/101149

Title

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

Author(s)

Guerra-Farfan E.
 Borges F.K.
 Bhandari M.
 Garcia-Sanchez Y.
 Nuoez J.H.
 Mestre-Torres J.
 Tomas-Hernandez J.
 Teixidor-Serra J.
 Balaguer-Castro M.
 Castillon P.
 Dealbert A.
 De Caso Rodriguez J.
 Aguado H.J.
 Guerado E.
 Popova E.
 Tonelli A.C.
 Balasubramanian K.
 Vincent J.
 Harvey V.
 Kocaqi E.
 Slobogean G.
 Devereaux P.J.
 Veevaete L.
 Waroux B.l.P.d.
 Lavand'homme P.
 Cornu O.
 Tribak K.
 Yombi J.C.
 Touil N.
 Bhutia J.T.
 Clinckaert C.
 Clippeleir D.D.
 Reul M.
 Patel A.
 Tandon V.
 Gauthier L.P.
 Avram V.R.A.
 Winemaker M.
 de Beer J.
 Simpson D.L.
 Worster A.
 Alvarado K.A.
 Gregus K.K.
 Lawrence K.H.
 Leong D.P.
 Joseph P.G.
 Magloire P.
 Deheshi B.
 Bisland S.
 Wood T.J.
 Tushinski D.M.
 Wilson D.A.J.
 Haider S.
 Bali K.
 Kearon C.
 Manach Y.L.
 Adili A.
 Tiboni M.E.
 Neary J.D.
 Cowan D.D.
 Khanna V.
 Zaki A.
 Farrell J.C.
 MacDonald A.M.
 Conen D.
 Wong S.C.W.
 Karbassi A.
 Wright D.S.
 Shanthanna H.
 Coughlin R.
 Khan M.
 Wikkerink S.
 Quraishi F.A.
 Lawendy A.R.
 Kishta W.
 Schemitsch E.
 Carey T.
 Macleod M.D.
 Sanders D.W.
 Vasarhelyi E.
 Bartley D.
 Dresser G.K.
 Tieszer C.
 Jenkinson R.J.
 Shadowitz S.
 Lee J.S.
 Choi S.
 Kreder H.J.
 Nousiainen M.
 Kunz M.R.
 Tuazon R.
 Shrikumar M.
 Ravi B.
 Wasserstein D.
 Stephen D.J.G.
 Nam D.
 Henry P.D.G.
 Wood G.C.A.
 Mann S.M.
 Jaeger M.T.

Author's Affiliation

Michael G. DeGroote School of Medicine
 Vall d'Hebron Institut de Recerca
 Population Health Research Institute, Ontario
 Universitair Ziekenhuis Brussel
 Centro Medico Teknon
 McMaster University
 Hospital Clínic de Barcelona
 London Health Sciences Centre
 Sunnybrook Health Sciences Centre
 Universitat Autònoma de Barcelona
 Hospital Costa Del Sol
 Hospital Clínico Universitario de Valladolid
 University of Maryland, College Park
 Mutua de Terrassa
 Hospital de Clinicas de Porto Alegre
 Hospital Regional Universitario Carlos Haya
 R Adams Cowley Shock Trauma Center
 Cliniques Universitaires Saint-Luc
 Hospital Universitari Vall d'Hebron
 Hospital Universitari de Bellvitge
 Hospital de La Santa Creu I Sant Pau
 Parc Taulí Hospital Universitari (87)
 St. Joseph's Healthcare (134)
 Canada (983) – Juravinski Hospital and Cancer Centre (293)
 Hospital Sant Camil (37)
 Kingston Health Sciences Centre
 Consorci Sanitari del Garraf

Corresponding Author(s)

Guerra-Farfan E.

Other Contributor(s)

Mahidol University

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

Keyword(s)

Medicine

Availability

URI

https://repository.li.mahidol.ac.th/handle/20.500.14594/101149

Collections

Scopus 2024