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

38768470
IJS-D-24-01888
10.1097/JS9.0000000000001673
00086
3
Correspondence
Enhancing the validity of mortality prediction models in orthopedic surgery: two critical evaluations
Guo Xianghong MM ahongxing0073@163.com

Yang Ya MM b1550204564@qq.com

Luo Jingling MD luojl20240101@163.com
a*
a Department of Orthopedics, Qujing Second People's Hospital, Qujing Central Hospital of Yunnan Regional Medical Center, Qujing, China
b Department of Gastroenterology, Qujing First People's Hospital, Qujing Central Hospital of Yunnan Regional Medical Center, Qujing, China
* Corresponding author. Address: Department of Orthopedics, Qujing Second People’s Hospital, Qujing Central Hospital of Yunnan Regional Medical Center, No. 289, Qilin West Road, Qilin District, Qujing City, Yunnan Province, People’s Republic of China. Tel.: +86 158 874 796 33. E-mail: luojl20240101@163.com (J. Luo).
9 2024
20 5 2024
110 9 59105911
8 5 2024
9 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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pmcWe read a recent article by Guo et al.1 published in the International Journal of Surgery with great interest. This prospective multicenter cohort study aimed to develop a mortality prediction model for patients undergoing surgery for intertrochanteric femoral fractures by investigating perioperative transfusion-related factors and variables. This study offers valuable insights into the treatment of patients with intertrochanteric femoral fractures, thus assisting in the optimization of individualized treatment strategies. We hope to raise several points for further discussion.

First, the study included patients from January 2018 to June 2021 with a 2-year follow-up period, which coincides with the coronavirus disease 2019 (COVID-19) pandemic, during which numerous studies reported increased mortality rates for various diseases associated with COVID-19. In a cohort study of patients with hip fracture patients, those who tested positive for COVID-19 at admission were more commonly male and had a more than two-fold increase in the risk of death within 90 days post-fracture2. Another study reported a significantly higher risk of perioperative complications and a more than ten-fold increase in the in-hospital mortality rate in COVID-19-positive patients3. Given the higher proportion of male participants in Guo et al. study and the lack of a clear evaluation of COVID-19 infection, this could significantly affect the reported mortality statistics. We suggest that the authors supplement the relevant information to further assess the impact of this factor on their results.

Second, a multidisciplinary co-management model can significantly reduce the length of hospital stay of patients with hip fractures and decrease the incidence of complications and mortality rates4. However, the level of collaboration in the co-management model varies among hospitals, which directly affects the clinical efficacy. In the hospitals involved in this study, two hospitals had orthopedic departments that belonged to their absolute dominant departments, and both of these hospitals adopted a tight co-management model; however, Guo et al. did not explore the specific efficacy evaluation of multidisciplinary assistance within this model, which may affect the generalizability of the predictive model to other hospitals. Therefore, categorizing the validation cohorts by hospital and conducting validation and comparison using the predictive model can provide a clearer understanding of the impact of different co-management models on this predictive model. This offers a more comprehensive assessment of the accuracy of the predictive model for future dissemination and application.

Finally, the treatment of hip fractures presents not only a challenge for orthopedic surgeons but also imposes a significant societal burden. We encourage the authors to continue their research efforts to provide more credible evidence to improve the treatment of hip fractures.

Ethical approval

Not applicable.

Consent

Patient or volunteer consent: not applicable.

Sources of funding

Not applicable.

Author contribution

X.G. and Y.Y.: conceptualization and writing – original draft and critical revision; J.L.: writing – review and editing.

Conflicts of interest disclosure

The author declares no conflict of interest.

Research registration unique identifying number (UIN)

Not applicable.

Guarantor

Xianghong Guo.

Data availability statement

The data supporting the findings of this study are available upon reasonable request from the corresponding author, Jingling Luo.

Provenance and peer review

Not commissioned, externally peer-reviewed.

Acknowledgements

Not applicable.

Xianghong Guo and Ya Yang contributed equally to this article.

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

Published online 20 May 2024
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References

1 Guo J Geng Q Xu K . Development and validation of models for predicting mortality in intertrochanteric fracture surgery patients with perioperative blood transfusion: a prospective multicenter cohort study. Int J Surg 2024. [Epub ahead of print]. doi:10.1097/JS9.0000000000001472
2 Holleyman RJ Khan SK Charlett A . The impact of COVID-19 on mortality after hip fracture: a population cohort study from England. Bone Joint J 2022;104-B :1156–1167.36177635
3 Zhong H Poeran J Liu J . Hip fracture characteristics and outcomes during COVID-19: a large retrospective national database review. Br J Anaesth 2021;127 :15–22.33965205
4 Fischer H Maleitzke T Eder C . Management of proximal femur fractures in the elderly: current concepts and treatment options. Eur J Med Res 2021;26 :86.34348796
