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Kowark A, Adam C, Ahrens J, Bajbouj M, Bollheimer C, Borowski M, Dodel R, Dolch M, Hachenberg T, Henzler D, Hildebrand F, Hilgers RD, Hoeft A, Isfort S, Kienbaum P, Knobe M, Knuefermann P, Kranke P, Laufenberg-Feldmann R, Nau C, Neuman MD, Olotu C, Rex C, Rossaint R, Sanders RD, Schmidt R, Schneider F, Siebert H, Skorning M, Spies C, Vicent O, Wappler F, Wirtz DC, Wittmann M, Zacharowski K, Zarbock A, Coburn M. Improve hip fracture outcome in the elderly patient (iHOPE): a study protocol for a pragmatic, multicentre randomised controlled trial to test the efficacy of spinal versus general anaesthesia. BMJ Open 2018; 8:e023609. [PMID: 30341135 PMCID: PMC6196806 DOI: 10.1136/bmjopen-2018-023609] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/24/2018] [Accepted: 09/12/2018] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Hip fracture surgery is associated with high in-hospital and 30-day mortality rates and serious adverse patient outcomes. Evidence from randomised controlled trials regarding effectiveness of spinal versus general anaesthesia on patient-centred outcomes after hip fracture surgery is sparse. METHODS AND ANALYSIS The iHOPE study is a pragmatic national, multicentre, randomised controlled, open-label clinical trial with a two-arm parallel group design. In total, 1032 patients with hip fracture (>65 years) will be randomised in an intended 1:1 allocation ratio to receive spinal anaesthesia (n=516) or general anaesthesia (n=516). Outcome assessment will occur in a blinded manner after hospital discharge and inhospital. The primary endpoint will be assessed by telephone interview and comprises the time to the first occurring event of the binary composite outcome of all-cause mortality or new-onset serious cardiac and pulmonary complications within 30 postoperative days. In-hospital secondary endpoints, assessed via in-person interviews and medical record review, include mortality, perioperative adverse events, delirium, satisfaction, walking independently, length of hospital stay and discharge destination. Telephone interviews will be performed for long-term endpoints (all-cause mortality, independence in walking, chronic pain, ability to return home cognitive function and overall health and disability) at postoperative day 30±3, 180±45 and 365±60. ETHICS AND DISSEMINATION: iHOPE has been approved by the leading Ethics Committee of the Medical Faculty of the RWTH Aachen University on 14 March 2018 (EK 022/18). Approval from all other involved local Ethical Committees was subsequently requested and obtained. Study started in April 2018 with a total recruitment period of 24 months. iHOPE will be disseminated via presentations at national and international scientific meetings or conferences and publication in peer-reviewed international scientific journals. TRIAL REGISTRATION NUMBER DRKS00013644; Pre-results.
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Affiliation(s)
- Ana Kowark
- Department of Anaesthesiology, Medical Faculty RWTH Aachen University, Aachen, Germany
| | - Christian Adam
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Klinikverbund St. Antonius und St. Josef GmbH, Wuppertal, Germany
| | - Jörg Ahrens
- Department of Anaesthesiology and Intensive Care, Medical University Hannover, Hannover, Germany
| | - Malek Bajbouj
- Psychiatry and Affective Neurosciences, Campus Benjamin Franklin, Charité Center Neurology, Neurosurgery and Psychiatry, Berlin, Germany
| | - Cornelius Bollheimer
- Department of Geriatric Medicine, Medical Faculty RWTH Aachen University, Aachen, Germany
| | - Matthias Borowski
- Institute of Biostatistics and Clinical Research, University of Muenster, Münster, Germany
| | - Richard Dodel
- Department of Geriatrics, University Hospital Essen, Essen, Germany
| | - Michael Dolch
- Department of Anaesthesiology, Ludwig-Maximilian University (LMU) Munich, Munich, Germany
| | - Thomas Hachenberg
- Department of Anaesthesiology and Intensive Care, University Hospital Magdeburg, Magdeburg, Germany
| | - Dietrich Henzler
- Department of Anaesthesiology, Surgical Intensive Care, Emergency and Pain Medicine, Ruhr-University Bochum, Klinikum Herford, Herford, Germany
| | - Frank Hildebrand
- Department of Orthopaedic Trauma Surgery, Medical Faculty RWTH Aachen University, Aachen, Germany
| | - Ralf-Dieter Hilgers
- Department of Medical Statistics, Medical Faculty RWTH Aachen University, Aachen, Germany
| | - Andreas Hoeft
- Department of Anaesthesiology and Operative Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Susanne Isfort
- Center for Translational & Clinical Research Aachen (CTC-A), Medical Faculty RWTH Aachen University, Aachen, Germany
| | - Peter Kienbaum
- Department of Anaesthesiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Mathias Knobe
- Department of Orthopaedic Trauma Surgery, Medical Faculty RWTH Aachen University, Aachen, Germany
| | - Pascal Knuefermann
- Department of Anaesthesiology, Gemeinschaftskrankenhaus Bonn, Bonn, Germany
| | - Peter Kranke
- Department of Anaesthesiology, University Hospital Würzburg, Würzburg, Germany
| | - Rita Laufenberg-Feldmann
- Department of Anaesthesiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Carla Nau
- Department of Anaesthesiology and Intensive Care, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Mark D Neuman
- Department of Anaesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cynthia Olotu
- Department of the Geriatric Anaesthesiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Christopher Rex
- Department of Anaesthesiology and Intensive Care, Reutlingen Hospital GMBH, Reutlingen, Germany
| | - Rolf Rossaint
- Department of Anaesthesiology, Medical Faculty RWTH Aachen University, Aachen, Germany
| | - Robert D Sanders
- Department of Anesthesiology, University of Wisconsin – Madison, Madison, Wisconsin, USA
| | - Rene Schmidt
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty RWTH Aachen University, Stuttgart, Germany
| | - Frank Schneider
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty RWTH Aachen University, Aachen, Germany
- Institute for Neuroscience and Medicine (INM-10), Research Centre Jülich, Jülich, Germany
| | | | - Max Skorning
- Section Patient Safety, Medical Advisory Service of Social Health Insurance, Essen, Germany
| | - Claudia Spies
- Department of Anaesthesiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Oliver Vicent
- Department of Anaesthesiology and Intensive Care, University Hospital Dresden, Dresden, Germany
| | - Frank Wappler
- Department of Anaesthesiology and Operative Intensive Care, University Witten/Herdecke, Witten/Herdecke, Germany
| | | | - Maria Wittmann
- Department of Anaesthesiology and Operative Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Kai Zacharowski
- Department of Anaesthesiology, Intensive Care and Pain Therapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Alexander Zarbock
- Department of Anaesthesiology, Intensive Care and Pain Therapy, University Hospital Muenster, Muenster, Germany
| | - Mark Coburn
- Department of Anaesthesiology, Medical Faculty RWTH Aachen University, Aachen, Germany
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