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Comment & Response
June 5, 2018

Wait Time for Hip Fracture Surgery and Mortality—Reply

Author Affiliations
  • 1University of Toronto, Toronto, Ontario, Canada
JAMA. 2018;319(21):2234-2235. doi:10.1001/jama.2018.4426

In Reply Dr Okada and colleagues and Dr Haviari are concerned about residual confounding. Our objective was to define a time-to-surgery threshold after hip fracture indicative of increased risk, if one existed. We found that the adjusted risk of developing complications increased when the wait time was greater than 24 hours, irrespective of the complication or follow-up period considered when time was analyzed as a continuous variable. Comparing propensity score–matched groups, assessing the area under the receiver operating characteristic curve, and performing several sensitivity analyses added to the robustness of this definition. We caution against assuming that the observational study is confounded for these reasons.