HIP ATTACK is the largest RCT to test whether operating within 6 hours of hip fracture diagnosis improves outcomes versus standard care. It enrolled 2970 patients across 69 hospitals in 17 countries. The trial directly challenges the widely-held assumption, built on observational data, that faster surgery saves lives.
For years, observational data drove aggressive OR prioritisation for hip fracture under the assumption that faster surgery saves lives. HIP ATTACK is the definitive RCT that tests this assumption — and finds it does not hold for mortality or major complications at the population level.
The practical takeaway is nuanced: rushing to the OR within 6 hours still matters, but the benefits are in delirium reduction, faster mobilisation, and 1 day shorter stay — not survival. Frame OR prioritisation for hip fracture patients around these benefits when discussing the pathway with your team.
The troponin subgroup is the most clinically actionable finding to watch. Patients with elevated troponin at presentation had nearly half the mortality with accelerated surgery (HR 0.43). Check a troponin on admission — if it is elevated, the case for moving quickly is strongest.
The stroke reduction (HR 0.35) looks compelling but has a fragility index of 2. Do not cite this as a reliable benefit of accelerated surgery without that caveat.
HIP ATTACK is the largest RCT to test whether operating within 6 hours of hip fracture diagnosis improves outcomes versus standard care. It enrolled 2970 patients across 69 hospitals in 17 countries. The trial directly challenges the widely-held assumption, built on observational data, that faster surgery saves lives.
For years, observational data drove aggressive OR prioritisation for hip fracture under the assumption that faster surgery saves lives. HIP ATTACK is the definitive RCT that tests this assumption — and finds it does not hold for mortality or major complications at the population level.
The practical takeaway is nuanced: rushing to the OR within 6 hours still matters, but the benefits are in delirium reduction, faster mobilisation, and 1 day shorter stay — not survival. Frame OR prioritisation for hip fracture patients around these benefits when discussing the pathway with your team.
The troponin subgroup is the most clinically actionable finding to watch. Patients with elevated troponin at presentation had nearly half the mortality with accelerated surgery (HR 0.43). Check a troponin on admission — if it is elevated, the case for moving quickly is strongest.
The stroke reduction (HR 0.35) looks compelling but has a fragility index of 2. Do not cite this as a reliable benefit of accelerated surgery without that caveat.