November 19, 2013
Older Patients Recover Better When Hip Fracture Surgery Comes Early
April Flowers for redOrbit.com - Your Universe Online
A research team from McMaster University reports that the speed of surgery after a hip fracture may have a significant impact on outcomes for older patients. According to the findings, faster may be better.Hip fractures can cause serious complications for seniors that may result in death or admission to long-term care facilities for individuals who previously lived at home. Pain, bleeding and immobility can all be caused by hip fractures, which can also activate a patient's coagulation and stress systems, which can lead to medical complications in people awaiting surgery.
In many nations, including Canada, patient waits for hip surgery can be 24 hours or longer. This is mainly because of pre-surgery clearance procedures and a lack of available operating rooms.
The research team recruited 60 people aged 45 or older who had been diagnosed with a hip fracture requiring surgery on a weekday during daytime working hours in order to determine whether early surgery improves outcomes for people with hip fractures. The participants -- recruited from 2 hospitals in Hamilton, Ontario, Canada, and 1 in Pune, India -- were randomized into two equal sized groups. One group of patients received accelerated care, while the second group received standard care as a control. The results were published in a recent issue of the Canadian Medical Association Journal (CMAJ).
The average age of the study subjects was 81 years and 63 percent of the total were female. Many of the patients had several illnesses as well as the hip fracture: 68 percent had hypertension, 20 percent had coronary artery disease, and 17 percent had dementia. In the accelerated care group, the median time between diagnosis with fracture and clearance for surgery was 1.5 hours. In contrast, the average wait time in the control group was 3.4 hours. From diagnosis to surgery, the average time for the accelerated care group was 6 hours, while in the control group it was 24.2 hours.
The outcomes varied greatly between the groups. In the accelerated care group, 30 percent suffered a major complication of death, heart attack, stroke, pneumonia, blood clot or major bleeding event. In the control group, however, 47 percent suffered one of these complications.
"We believe that the shortest time possible to treatment may provide the greatest potential for benefit, as is the case in acute heart attack and stroke," said Dr. P.J. Devereaux, an associate professor of medicine and epidemiology at the Michael G. DeGroote School of Medicine at McMaster and co-principal investigator of the pilot trial.
"This pilot trial demonstrates the feasibility of a trial comparing accelerated and standard care among patients with a hip fracture," conclude the authors.
"The results provide encouraging evidence that accelerated surgery may substantially improve outcomes in these patients," states Dr. Mohit Bhandari, McMaster University, co-principal investigator of the HIP ATTACK pilot trial.
The team will conduct a full scale trial in 2014. They have invited interested researchers to join them in the study.