HIP ATTACK randomized 2,970 hip fracture patients at 69 hospitals across 17 countries to surgery within 6 hours versus standard care. The trial asked whether getting to the OR faster reduces 90-day mortality or major complications. It is the largest RCT ever conducted on surgical timing for hip fracture.
Observational studies had consistently suggested earlier hip fracture surgery reduces mortality, and that data drove institutional pressure to operate as fast as possible. HIP ATTACK — the first large RCT on this question. Shows that relationship was confounded: moving surgery up by 18 hours does not change who lives or who suffers a major complication at 90 days.
In clinical practice, this means you should not skip or abbreviate necessary medical optimization to hit an arbitrary 6-hour target. The pressure to clear patients immediately does not have mortality data behind it.
What accelerated surgery does deliver is real: less delirium, fewer UTIs, earlier mobilization, and 1 fewer hospital day. These are worth pursuing through systems-level pathways, just not at the cost of patient safety.
The one group where speed may genuinely matter is patients with elevated preoperative troponin (mortality 10% vs 24% in this post-hoc analysis). The authors call for dedicated research in this subgroup. Until then, treat it as a hypothesis worth tracking, not a protocol change.
HIP ATTACK randomized 2,970 hip fracture patients at 69 hospitals across 17 countries to surgery within 6 hours versus standard care. The trial asked whether getting to the OR faster reduces 90-day mortality or major complications. It is the largest RCT ever conducted on surgical timing for hip fracture.
Observational studies had consistently suggested earlier hip fracture surgery reduces mortality, and that data drove institutional pressure to operate as fast as possible. HIP ATTACK — the first large RCT on this question. Shows that relationship was confounded: moving surgery up by 18 hours does not change who lives or who suffers a major complication at 90 days.
In clinical practice, this means you should not skip or abbreviate necessary medical optimization to hit an arbitrary 6-hour target. The pressure to clear patients immediately does not have mortality data behind it.
What accelerated surgery does deliver is real: less delirium, fewer UTIs, earlier mobilization, and 1 fewer hospital day. These are worth pursuing through systems-level pathways, just not at the cost of patient safety.
The one group where speed may genuinely matter is patients with elevated preoperative troponin (mortality 10% vs 24% in this post-hoc analysis). The authors call for dedicated research in this subgroup. Until then, treat it as a hypothesis worth tracking, not a protocol change.