In reply: Reassessment of a meta-analysis of intraoperative cerebral-oximetry-based management studies
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CORRESPONDENCE
In reply: Reassessment of a meta-analysis of intraoperative cerebral-oximetry-based management studies Andre´s Zorrilla-Vaca, BSc
. Ryan Healy, BSc
Received: 22 November 2018 / Revised: 3 February 2019 / Accepted: 13 April 2019 Canadian Anesthesiologists’ Society 2019
To the Editor, In response to the letter by Davis and Saunders,1 we carefully reviewed our article published earlier in the Journal.2 First, on re-review of our original paper, we noted that we had mislabelled Figs 5 and 6 leading Davis and Saunders to mistakenly note that six articles were analyzed for postoperative delirium (POD) as shown erroneously in Fig. 6. Importantly, we did correctly state that, ‘‘Four RCTs specifically assessed for postoperative delirium. There was no significant difference…’’ and if Figs 5 and 6 had been correctly labelled, it would have been clear that both figures correspond to data of red blood cell transfusions (six articles) and that none of the graphs presented data related to POD. Specifically, Fig. 5 represents the overall analysis for transfusions while Fig. 6 corresponds to a subgroup analysis of transfusion outcome. In re-reviewing our original submission, we now realize that the pooled risk ratio reported in Fig. 5 is not the same as that reported in the text (risk ratio, 0.90; 95 % confidence interval [CI], 0.63 to 1.29; P = 0.57), which was very similar to the effect size noted in the reanalysis of Davis and Saunders. Nevertheless, we included the following four studies in the analysis of POD (according
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12630-019-01470-0) contains supplementary material, which is available to authorized users. A. Zorrilla-Vaca, BSc (&) School of Medicine, Universidad del Valle, Hospital Universitario del Valle, Cali, Colombia e-mail: [email protected] R. Healy, BSc Graduate Medical Sciences, Boston University School of Medicine, Boston, MA, USA
to the table published in the original article) instead of only three articles (included by Davis and Saunders): Ballard et al. (non-published data provided by authors),3 Colak et al.,4 Deschamps et al.,5 and Lei et al.6 We apologize for this error in Figs 5 and 6 of our original manuscript and emphasize that the values for POD reported in the text remain the correct ones. The correct figures can now be seen in the Electronic Supplementary Material (ESM). Davis and Saunders also found inconsistences in the number of transfusions that we reported from the study by Colak et al. This was due to a misinterpretation on our part of the term ‘‘w/o’’ in their Table 2, which was not explained in the legends. We also did note the error of including the study by Cohn et al., which monitored oximetry on the thenar eminence rather than cerebral oximetry. Therefore, in the reanalysis we excluded Cohn et al. from the length of hospital stay outcome and found a similar non-significant result (standardized mean difference [SMD] -0.07; 95% CI, -0.19 to 0.05; P = 0.26).
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