PONE-D-24-28136

Development and Validation of a Risk Prediction Model for Severe Postoperative Complications in Elderly Patients with Hip Fracture

PLOS ONE

Dear Dr. Chen,

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Barry Kweh

Academic Editor

PLOS ONE

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Additional Editor Comments:

An interesting study based upon novel data which requires a broader discussion of other frailty index stratification tools and a stronger argument as to why the authors' instruments is superior to others.

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Reviewers' comments:

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Comments to the Author

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Reviewer #1: Yes

Reviewer #2: No

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: No

Reviewer #2: No

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Reviewer #1: Yes

Reviewer #2: No

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Reviewer #1: Yes

Reviewer #2: No

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Reviewer #1: Reviewer Comments:

This study summarizes and statistically analyzes 390 hip fracture surgery patients to identify potential risk factors for postoperative complications, concluding that mFI-5 and CAR are predictors of severe complications in hip fracture patients. This study has clinical significance and is a valuable paper. The following modifications are recommended:

1.This study included a total of 390 cases and was divided into a training group and a validation group. For epidemiological research, the sample size is slightly small.

2.This study is a single-center study. Can the patient population at your institution represent the entire population of patients with this disease?

3.For hip fracture patients, it is recommended to perform detailed classification rather than just dividing them into femoral neck fractures and intertrochanteric fractures. I believe that the severity of the fracture also has a significant impact on postoperative complications. For example, type IV comminuted fractures should also be analyzed as predictive factors.

4.This study is a retrospective study that selected inpatient case data. How was the grouping of cases determined? If not randomized, the statistical results in the training group may be biased.

5.What is the observation period for severe complications in this study? Only retrospective analysis of in-hospital data—are these data sufficient? What was your average hospital stay?

6.Additionally, for severe complications that occurred during hospitalization, your results show that they account for 1/4 of the total cases. This proportion seems a bit high.

Reviewer #2: This study aimed to investigate risk factors associated with severe postoperative complications following hip fracture surgery in elderly patients and to develop a nomogram-based risk prediction model for these complications. They found both the mFI-5 and CAR are predictive factors for severe postoperative complications in elderly patients undergoing hip fracture surgery.This study is not novel enough to be accepted.

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Reviewer #1: No

Reviewer #2: No

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PONE-D-24-28136R1Development and validation of a risk prediction model for severe postoperative complications in elderly patients with hip fracturePLOS ONE

Dear Dr. Chen,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Oct 06 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Barry Kweh

Academic Editor

PLOS ONE

Additional Editor Comments:

This is a retrospective cohort with its inherent weaknesses but provides original data on the utility of risk prediction in a vulnerable group of patients. The authors have revised their paper to strengthen the discussion.

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[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Development and validation of a risk prediction model for severe postoperative complications in elderly patients with hip fracture

PONE-D-24-28136R2

Dear Dr. Chen,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Barry Kweh

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

The authors have clarified their dataset and statistical analysis as well as now including baseline surgical and medical complication rates in their manuscript to strengthen the discussion.

Reviewers' comments: