To The Editor:
We read with great interest the paper of Keating and colleagues [1]. The results, especially those of the economic analysis, are of great
importance to a health care financing agency like the Hungarian National
Health Insurance Fund Administration (OEP), which provides full health
insurance coverage for 10.2 million people in a single payer system [2].
However, such a study raises interesting questions about how the results of a large randomized
trial relate to everyday medical practice [3]. In order to analyze the
relationship between surgical methods and mortality after femoral neck
fracture, we analyzed the survival rates of all patients who sustained a
displaced intracapsular femoral neck fracture in 2000. Data were extracted
from the nationwide database of the National Health Insurance Fund
Administration; we verified our administrative data by a questionnaire completed by the participating hospitals.
Altogether, 2558 patients from all of Hungary were included in
the study (mean age=78.14 ± 8.410). 2124 patients (mean age=78.26 ± 8.501)
underwent reduction and fixation and 434 patients (mean age=77.53 ± 7.933) underwent
arthroplasty (including hemi and total). One-way analysis of variance
(ANOVA) showed no significant difference in the mean age of the patient
groups (F=2.724, P=0.099).
Figure 1(below) shows the Kaplan-Meier survival curves of patients according to
surgical methods. Overall survival at 2170 days follow up was 33.97 % with
significant differences in mortality according to the type of surgical method: reduction and
fixation 32.72; % and arthroplasty 40.09 %. (log rank test 11.53, df=1, p<0.0007).
Although we did not stratifiy the patients according
to health status (with or without co-morbidities) or further complications
(with or without reoperation), we would like to emphasize that the results
coming from even a well-designed randomized trial may differ from similar
outcome measures analyzed on a nationwide administrative dataset of
unselected patients.
Fig. 1
References:
1. Keating JF, Grant A, Masson M, Scott NW, Forbes JF on behalf of
the Scottish Orthopaedic Trials Network. Randomized comparison of
reduction and fixation, bipolar hemiarthroplasty, and total hip
arthroplasty. Treatment of displaced intracapsular hip fractures in
healthy older patients. J Bone Joint Surg Am. 2006; 88:249-260.
2. Boncz I, Nagy J, Sebestyén A, Kõrösi L (2004) Financing of health care
services in Hungary. Eur J Health Econ. 2004; 5(3):252-258.
3. Fisher CB. Clinical trials results databases: unanswered questions.
Science, 2006; 311: 180-181.
Letters to the Editor: ![[Read Letter to the Editor]](/icons/misc/sectionDOWN.gif){kind=icon}
