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Post-operative mortality related to waiting time for hip fracture surgery
Injury, Int. J. Care Injured (2005) 36, 984—988
www.elsevier.com/locate/injury
LETTER TO THE EDITOR Post-operative mortality related to waiting time for hip fracture surgery We read with interest the paper from Casaletto and Gatt.1 We would like to make a few observations on the study. A change in policy for hip fracture management led to an excellent opportunity to examine the effect of operative delay on mortality. The authors have clearly demonstrated that the two cohorts have significantly different mortality rates and that the delay profile is also clearly significantly different. The evidence in the paper does not support the main conclusion that ‘‘This study shows that survival at 1 year is better when patients who are medically fit for surgery are operated on the same day of admission’’. It does support the conclusion that the change of policy was associated with significantly worse survival after June 1995. The proportion of patients in the more than 1-day wait group was 13% in both cohorts, but the paper does not make clear how many patients waited 2, 3 or more days in each cohort. The contribution of longer delays to the calculation of mean number of days to surgery is not clear as a result. It is possible as a result of random variation or factors beyond the control of the study that a greater number of medically unfit patients were admitted in the second cohort, which could introduce a significant bias. In comparing the two groups, it would have been appropriate to include an assessment of medical comorbidity as a significantly higher level of this in the second cohort could account both for increased delay and increased mortality. The mortality rate for the patients operated on the day of admission is not recorded in the paper, and is not compared with mortality rates for operations performed on the following or subsequent days. Most previous studies are either equivocal3 or relate increase in mortality to longer preoperative delays.4 An audit in our own unit indicated delays over 48 h led to increased mortality where delays occurred for non-medical reasons.2 It would therefore be very interesting to see the mortality rates for each period of delay to surgery, as a clear,
beneficial, difference between the patients operated on the day of admission and subsequent days would support the authors’ main conclusion. One would anticipate that this information should be readily available from the raw data.
References 1. Casaletto JA, Gatt R. Post-operative mortality related to waiting time for hip fracture surgery. Injury 2004;35:114—20. 2. Cooper JP, Parks JW, Harries ML, Craigen MAC. The effect of surgical delay on mortality of patients with hip fractures. JBJS 2003;85-B(Suppl II):122—3. 3. Davidson TI, Bodey WN. Factors influencing survival following fractures of the upper end of the femur. Injury 1986;17:12—4. 4. Zuckerman JD, Skovron ML, Koval KJ, et al. Postoperative complications and mortality associated with operative delay in older patients who have a fracture of the hip. JBJS 1995;77A:1551—6.
R. Bansal J. Luscombe J.P. Cooper Selly Oak Hospital, Trauma and Orthopedics Birmingham B29 6JD, UK E-mail address: [email protected] 11 November 2004 doi:10.1016/j.injury.2004.11.017
LETTER TO THE EDITOR Prediction of fixation failure after sliding hip screw fixation [Injury 2004;35:994—8] I read with interest the paper ‘Prediction of fixation failure after sliding hip screw fixation’ by Pervez et al.1 It is a quick and reproducible method of assessing fixation of hip fractures with sliding DOI of original article: 10.1016/j.injury.2004.12.043
0020–1383/$ — see front matter # 2004 Elsevier Ltd. All rights reserved.
www.elsevier.com/locate/injury
LETTER TO THE EDITOR Post-operative mortality related to waiting time for hip fracture surgery We read with interest the paper from Casaletto and Gatt.1 We would like to make a few observations on the study. A change in policy for hip fracture management led to an excellent opportunity to examine the effect of operative delay on mortality. The authors have clearly demonstrated that the two cohorts have significantly different mortality rates and that the delay profile is also clearly significantly different. The evidence in the paper does not support the main conclusion that ‘‘This study shows that survival at 1 year is better when patients who are medically fit for surgery are operated on the same day of admission’’. It does support the conclusion that the change of policy was associated with significantly worse survival after June 1995. The proportion of patients in the more than 1-day wait group was 13% in both cohorts, but the paper does not make clear how many patients waited 2, 3 or more days in each cohort. The contribution of longer delays to the calculation of mean number of days to surgery is not clear as a result. It is possible as a result of random variation or factors beyond the control of the study that a greater number of medically unfit patients were admitted in the second cohort, which could introduce a significant bias. In comparing the two groups, it would have been appropriate to include an assessment of medical comorbidity as a significantly higher level of this in the second cohort could account both for increased delay and increased mortality. The mortality rate for the patients operated on the day of admission is not recorded in the paper, and is not compared with mortality rates for operations performed on the following or subsequent days. Most previous studies are either equivocal3 or relate increase in mortality to longer preoperative delays.4 An audit in our own unit indicated delays over 48 h led to increased mortality where delays occurred for non-medical reasons.2 It would therefore be very interesting to see the mortality rates for each period of delay to surgery, as a clear,
beneficial, difference between the patients operated on the day of admission and subsequent days would support the authors’ main conclusion. One would anticipate that this information should be readily available from the raw data.
References 1. Casaletto JA, Gatt R. Post-operative mortality related to waiting time for hip fracture surgery. Injury 2004;35:114—20. 2. Cooper JP, Parks JW, Harries ML, Craigen MAC. The effect of surgical delay on mortality of patients with hip fractures. JBJS 2003;85-B(Suppl II):122—3. 3. Davidson TI, Bodey WN. Factors influencing survival following fractures of the upper end of the femur. Injury 1986;17:12—4. 4. Zuckerman JD, Skovron ML, Koval KJ, et al. Postoperative complications and mortality associated with operative delay in older patients who have a fracture of the hip. JBJS 1995;77A:1551—6.
R. Bansal J. Luscombe J.P. Cooper Selly Oak Hospital, Trauma and Orthopedics Birmingham B29 6JD, UK E-mail address: [email protected] 11 November 2004 doi:10.1016/j.injury.2004.11.017
LETTER TO THE EDITOR Prediction of fixation failure after sliding hip screw fixation [Injury 2004;35:994—8] I read with interest the paper ‘Prediction of fixation failure after sliding hip screw fixation’ by Pervez et al.1 It is a quick and reproducible method of assessing fixation of hip fractures with sliding DOI of original article: 10.1016/j.injury.2004.12.043
0020–1383/$ — see front matter # 2004 Elsevier Ltd. All rights reserved.