Hip fractures can be a game changer for Canadians. From loss of independence to admission in long term care facilities to death, sequelae of these fractures are serious.  As the authors of a new study point out, hip fractures cause pain, bleeding and immobility, and as patients wait for surgery the  medical complications can increase.

In Canada , waits for hip surgery can be 24 hours or longer, mainly because of ensuring a patient is fit for surgery and having access to an OR.

A new study reported in the CMAJ asked the question - does early surgery improve outcomes for people with hip fractures. In this Canadian study, researchers enrolled 60 people aged 45 years or older who were diagnosed with a hip fracture requiring surgery on a weekday during daytime working hours. The patients, from 2 hospitals in Hamilton, Ontario, Canada and 1 in Pune, India, were randomized to a group that received accelerated care (30 patients) and to a control group that received standard care (30 patients).

The average age was 81 years, and 63% were female. Many had several illnesses.  68% had hypertension, 20% coronary artery disease and 17% dementia. For patients in the accelerated care group, the median time between diagnosis with fracture and clearance for surgery was 1.5 hours compared with 3.4 hours in the standard care group. The median time from diagnosis to surgery was 6 hours for the accelerated care group, more than 18 hours less than the 24.2 hours to surgery in the standard care group.

The researchers set a target of 6 hours for accelerated surgery with the belief  that the shortest time possible will provide the greatest potential for benefit.  The study is called the HIP ATTACK pilot trial.