Episode 363: 262. Myocardial injury in patients with hip fracture

Is accelerated surgery for hip fracture better for high-risk patients?

A recent substudy of the HIP ATTACK trial has shed new light on this topic. The original trial, published in 2020, compared accelerated surgery (within 6 hours) to standard-timing surgery (within 24 hours) for hip fracture patients. While the initial results showed only marginal benefits, this new analysis focuses on a specific group: patients with elevated cardiac troponin levels at hospital arrival--- THE SICK GUYS

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.Here's what the researchers found:For patients with elevated troponin levels - about a quarter of those tested - accelerated surgery was associated with significantly lower mortality. The numbers are striking: 10% mortality in the accelerated surgery group compared to 23% in the standard surgery group. This translates to a number needed to treat of just 8

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.Interestingly, for patients with normal troponin levels, there was no significant difference in mortality between the two surgical approaches

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.These findings suggest that for high-risk patients - those with elevated troponin levels - immediate surgery without further work-up or delay could lead to better outcomes. It's a paradigm shift in how we approach these cases

.However, it's important to note that we're still awaiting results from the HIP ATTACK-2 study, which will provide more definitive evidence on whether accelerated surgery is superior to standard timing in these patients

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.In conclusion, this study highlights the potential benefits of tailoring surgical timing to individual patient risk factors. For those with elevated troponin levels, rapid intervention could be life-saving.

Borges FK et al. Myocardial injury in patients with hip fracture: A HIP ATTACK randomized trial substudy. J Bone Joint Surg Am 2024 Dec 18; 106:2303. (https://doi.org/10.2106/JBJS.23.01459)

Cornell C. Patients presenting with acute myocardial injury with hip fracture have greater survival with rapid surgical care. J Bone Joint Surg Am 2024 Dec 18; 106:e50. (https://doi.org/10.2106/JBJS.24.00583)