
==== Front
Int J Surg
Int J Surg
JS9
International Journal of Surgery (London, England)
1743-9191
1743-9159
Lippincott Williams & Wilkins Hagerstown, MD

38814277
IJS-D-24-02017
10.1097/JS9.0000000000001753
00114
3
Correspondence
Comment on “Development and validation of models for predicting mortality in intertrochanteric fracture surgery patients with perioperative blood transfusion: a prospective multicenter cohort study”
Liu Hui PhD hill0863@hotmail.com

Zhang Jinhui MD zhangjinhui301@hotmail.com

Wu Jin PhD *wujin1983@xmu.edu.cn

Department of Orthopaedics, The 909th Hospital, School of Medicine, Xiamen University, Fujian, China
* Corresponding author. Address: Department of Orthopaedics, the 909th Hospital, School of Medicine, Xiamen University, Fujian, China. Tel.: +86 059 629 315 38. E-mail: wujin1983@xmu.edu.cn (J. Wu).
9 2024
29 5 2024
110 9 59715972
13 5 2024
19 5 2024
Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/

OPEN-ACCESSTRUE
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pmc Dear Editor,

Guo et al.1 recently conducted a prospective multicenter cohort study investigating predictors of mortality in patients undergoing surgery for intertrochanteric fractures, focusing particularly on the impact of perioperative blood transfusion. The study identified several key predictors associated with increased mortality in this population. Notably, the number of transfusions, severe complications, American Society of Anesthesiologists (ASA) classification, modified Elixhauser’s Comorbidity Measure (mECM), and blood transfusion volume were significantly associated with mortality within 90 days. Additionally, age, ASA classification, blood transfusion volume, number of transfusions, and severe complications exhibited associations with mortality beyond 90 days, highlighting the complex interaction of these factors in predicting long-term outcomes following surgery for intertrochanteric fractures. These findings underscore the importance of comprehensive risk assessment and tailored management strategies to optimize patient care and postoperative survival in this vulnerable population. However, we note that there are some concerns within this study that require further elucidation.

Firstly, it is important to emphasize that perioperative blood transfusion encompasses a range of blood components, including red blood cells, plasma, platelets, or platelet-rich plasma (PRP)2–4. Notably, a meta-analysis5 of 78 randomized controlled trials has demonstrated that PRP transfusion significantly alleviates pain in orthopedic surgery patients, suggesting a potential improvement in patient prognosis with PRP transfusion. As described in the title of this study1, the participants were intertrochanteric fracture surgery patients who received perioperative blood transfusion. However, the study solely focused on red blood cell transfusion during the perioperative period, lacking information on plasma, platelets, or PRP transfusion. Given the current absence of studies reporting the relationship between plasma, platelets, or PRP transfusion and mortality in patients undergoing intertrochanteric fracture surgery, further exploration of these associations would be interesting. Investigating the impact of plasma, platelets, or PRP transfusion on mortality in this population could provide novel evidence for clinical decision-making, potentially guiding more tailored and effective management strategies to optimize postoperative outcomes and patient survival.

Secondly, there are numerous factors associated with mortality in intertrochanteric fracture surgery patients. For instance, a comprehensive study6 involving 1051 cases of intertrochanteric fractures demonstrated significant correlations between brain natriuretic peptide (BNP) levels and APACHE II scores with perioperative mortality outcomes. Additionally, research by Babagoli et al.7, utilizing multivariate analysis, identified neutrophil levels as a significant factor associated with in-hospital mortality in similar patient cohorts. However, the current study1 lacks critical information on BNP, APACHE II scores, and neutrophil levels. Considering that BNP, APACHE II score, and neutrophils can be easily extracted from medical records, further analysis of the relationship between these factors and short- and long-term mortality in intertrochanteric fracture surgery patients is necessary. Such analysis holds promise in refining patient risk stratification and informing more targeted and effective management strategies aimed at improving clinical outcomes and reducing mortality.

Thirdly, frailty is a well-recognized medical condition and a significant factor associated with surgical and treatment outcomes. In a study involving 229 patients with intertrochanteric femur fractures, Boissonneault et al.8. found that frailty was significantly associated with 30-day mortality. Similarly, another study9 with 45 979 participants demonstrated that frailty not only predicts in-hospital complications but is also significantly correlated with inpatient mortality, 6-month mortality, and more than or equal to 1-year mortality. While Guo et al.1. study focuses on both short- and long-term mortality, it is noteworthy that an important factor such as frailty was overlooked in that study. Thus, further exploration of frailty and its impact on mortality outcomes could enhance our understanding of patient risk stratification and guide the development of more comprehensive approaches to patient care and management strategies.

Ethical approval

Not applicable.

Source of funding

Not applicable.

Conflicts of interest disclosure

Not applicable.

Research registration unique identifying number (UIN)

Name of the registry:

Unique Identifying number or registration ID:

Hyperlink to your specific registration (must be publicly accessible and will be checked): Not applicable.

Guarantor

Jin Wu.

Data availability statement

This letter does not use any data.

Provenance and peer review

Commentary, internally reviewed.

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Published online 29 May 2024
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References

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