To the Editor Dr Pincus and colleagues1 found that increased wait time for hip fracture surgery was associated with greater risk for 30-day mortality. We would like to point out 3 concerns.
First, as Pincus and colleagues mentioned, confounding by indication may exaggerate the association of early surgery with mortality, with medically complex patients being predisposed to both complications and awaiting optimization, such as declining anticoagulant effect prior to surgery. Although the authors performed propensity score–matching analyses to adjust confounding factors and several sensitivity analyses to confirm the robustness of the results, propensity score analysis cannot reduce bias due to unmeasured confounding factors and confounding by indication cannot be mitigated by sensitivity analyses.
Okada E, Inukai K, Aoyama H. Wait Time for Hip Fracture Surgery and Mortality. JAMA. 2018;319(21):2233. doi:10.1001/jama.2018.4418
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