The separate or combined evaluation of co-morbidities have a different effect on the role of surgical delay on 1 year mortality.

Sir,

We read with great interest the excellent paper of Simunovic and colleagues providing a detailed systematic overview of different aspects of surgical delay following a hip fracture.1 We would like to add a new aspect to their paper regarding the evaluation of prognostic factors separately or combined.

We performed a study to evaluate the relationship between 1-year mortality following the treatment of femoral neck fracture and the usual risk factors (I) without differentiating and (II) with differentiating the comorbidities.2 Data were derived from the nationwide dataset of the Hungarian National Health Insurance Fund Administration, the single health care financing agency of Hungary. Data were evaluated according to sex, type of fracture (Garden I-II, Garden III-IV, extracapsular), patient turnover of institutions (volume), type of surgery (osteosynthesis/arthroplasty), early complications, hospital type (university clinics, capital, country, city), day of operation (week day, week-end), surgical delay (over 24 h, 12—24 h, 6—12 h, 0—6 h), different comorbidities according to ICD codes (C00–C97, D60—D64, E10—E16, F00—F99, G20—G26, G80—G83, I10—I15, I20—I25, I30—I52, I60—I69, I70, J00—J22, J40—J47, L89, N30—N39). Statistical analysis has been performed by multivariate logistic regression (odds ratio, 95% confidence interval, P). In the first case, we took the presence or absence of comorbidities as a single factor, while in the second case we analyzed all the 15 comorbidities separately. Results of the statistical analysis are presented in [Table 1].

Table 1

Multivariate analysis of prognostic factors of 1-year mortality following femoral neck fracture's surgery

Without differentiating comorbidities higher age, male gender, extracapsular fracture, longer surgical delay, osteosynthesis surgery and lower progressivity level of primary treatment proved to be of higher risk for one year mortality. In the case of osteosynthesis surgery, the negative risk is related to the poor general health status of patients, instead of the risk of surgery. With the differentiation of comorbidities mainly the role of surgical delay, sex, and partly the type of fracture is became weaker, while certain comorbidities (acute respiratory infections, other forms of heart diseases, malignant neoplasms, mental, and behavioral disorders) had higher risk for 1-year mortality.