TO THE EDITOR:
The article "Postoperative Complications and Mortality Associated with Operative Delay in Older Patients Who Have a Fracture of the Hip" (77-A: 1551—1556, Oct. 1995), by Zuckerman et al., indicated that operative delay of three calendar days or more from the time of admission doubles the risk of mortality within the first year after the fracture. From the standpoint of a community orthopaedist, it would have been helpful to determine if there were likewise risks in delaying the operation to the first or second day after admission as compared with performing the operation on the day of admission. It does not appear that Zuckerman et al. addressed this issue. Whether the operation is done on the day of admission or one or two days after admission is important to the community orthopaedist.
Dudley M. Baker, M.D.: 332 Dewey Street, Suite 200, Bennington, Vermont 05201
Dr. Zuckerman, Dr. Skovron, Dr. Koval, Ms. Aharonoff, and Dr. Frankel reply:
Dr. Baker raised an important question concerning the results of our study. Our initial analysis included the prevalence of complications and mortality for patients who had an operation on the day of admission and one, two, three, four, or five or more days after admission. On the basis of this initial analysis, with the numbers available, we could detect no significant difference in mortality between patients who had an operation on the day of admission and those who had it on the first or second day after admission. A significant difference in mortality was evident, however, for an operative delay of three days or more after admission. Therefore, a decision was made to stratify the analysis into two groups: patients who had an operation within two days after admission and patients who had an operation three days or more after admission. On the basis of the analysis, performing the operation on the day of admission or the first or second day after admission did not affect the one-year mortality or the prevalence of complications.
Joseph D. Zuckerman, M.D.; Mary Louise Skovron, Dr.P.H., Kenneth J. Koval, M.D., Gina Aharonoff, M.P.H.; Victor H. Frankel, M.D., Ph.D.: Geriatric Hip Fracture Research Group, Hospital for Joint Diseases, 301 East 17th Street, New York, N.Y. 10003