The Quality of Dying in Frail Institutionalized Older Patients After Nonoperative and Operative Management of a Proximal Femoral Fracture: An In-Depth Analysis.

Only patients who died and whose proxies answered the questionnaire were analysed, so the results apply to decedents, not to all patients with proximal femoral fracture. The final analysis included 53 nonoperative proxies and 21 operative proxies, and the study was not primarily powered to detect differences in quality of dying. Proxy response rates were 64% in the nonoperative group and 53% in the operative group, which may have introduced selection bias. Quality of dying was reported by proxies after death, not by patients themselves, and limited proxy characteristics were collected. Treatment was chosen through shared decision making, and the small sample did not allow adjustment for multiple possible confounders.

The authors declared no potential conflicts of interest. The work was supported by ZonMw and the Osteosynthesis and Trauma Care Foundation.

Do not conclude that nonoperative management is better or worse for quality of dying. The treatment choice was made through shared decision making, only patients who died and had proxy responses were analysed, and the study was not powered to detect differences in quality of dying.