Is Accelerated Surgery for Hip Fracture Better for High-Risk Patients?

In the HIP ATTACK trial (NEJM JW Gen Med Mar 15 2020 and Lancet 2020; 395:698), nearly 3000 patients who presented with hip fracture after low-energy trauma (e.g., ground-level fall) were randomized to undergo either accelerated surgery (i.e., within 6 hours) or standard-timing surgery (i.e., within 24 hours). Results showed marginal benefits in some secondary outcomes for accelerated surgery. Investigators have performed a substudy of the original trial data — focusing on the nearly 1400 patients for whom cardiac troponin tests were ordered at hospital arrival for hip fracture. The goal was to determine if timing of surgery affected outcomes in patients with elevated troponin levels and those with normal troponin.

Among patients with elevat…