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Comment & Response |

Cardiovascular Event Risk After Noncardiac Surgery—Reply

Mary T. Hawn, MD, MPH1; Joshua S. Richman, MD, PhD1; Thomas M. Maddox, MD, MSc2
[+] Author Affiliations
1Section of Gastrointestinal Surgery, University of Alabama, Birmingham
2University of Colorado, Denver
JAMA. 2014;311(5):525-526. doi:10.1001/jama.2013.285282.
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In Reply Drs Rassi and Yeh raise an important limitation of our study addressing the risk of noncardiac surgery in patients with recent coronary stent placement. They correctly point out that our study only included patients who successfully underwent surgery. As such, patients scheduled for surgery who had an intervening acute coronary event (potentially due to antiplatelet therapy cessation) would not be included in our cohort.

Therefore, we could be underreporting the actual rate of MACE due to antiplatelet therapy cessation in relation to planned surgery. During our chart review for the study, we identified a single case in which a patient was admitted with an acute coronary event following antiplatelet therapy cessation for surgery and the scheduled surgery was cancelled. The patient subsequently had surgery following stabilization and thus entered our cohort. Nevertheless, our study design did not allow for systematic identification of this clinical scenario.

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October 9, 2013
Mary T. Hawn, MD, MPH; Laura A. Graham, MPH; Joshua S. Richman, MD, PhD; Kamal M. F. Itani, MD; William G. Henderson, PhD; Thomas M. Maddox, MD, MSc
1Center for Surgical, Medical Acute Care Research and Transitions (C-SMART), Birmingham Veterans Administration Hospital, Birmingham, Alabama2Section of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham
1Center for Surgical, Medical Acute Care Research and Transitions (C-SMART), Birmingham Veterans Administration Hospital, Birmingham, Alabama
3Department of Surgery, VA Boston Health Care System, Boston University and Harvard Medical School, Boston, Massachusetts
4University of Colorado Health Outcomes Program and Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora
5VA Eastern Colorado Health Care System, Denver6University of Colorado, Denver
JAMA. 2013;310(14):1462-1472. doi:10.1001/jama.2013.278787.
February 5, 2014
Andrew N. Rassi, MD; Robert W. Yeh, MD, MSc
1Division of Cardiology, Massachusetts General Hospital, Boston
JAMA. 2014;311(5):525. doi:10.1001/jama.2013.285279.
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