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Comment & Response |

Long-term Survival Following Bariatric Surgery in the VA Health System—Reply

David E. Arterburn, MD, MPH1; George Eid, MD2; Matthew L. Maciejewski, PhD3
[+] Author Affiliations
1Group Health Research Institute, Seattle, Washington
2Pittsburgh Veterans Affairs Medical Center, Pittsburgh, Pennsylvania
3Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina
JAMA. 2015;313(14):1474-1475. doi:10.1001/jama.2015.2586.
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In Reply Retrospective studies relying on data derived from administrative claims and electronic health records often have incomplete capture of some patient-level covariates. These data are typically not captured to support research but to document clinical care and billing. Nevertheless, modern statistical techniques, such as sequential stratification used in our study, reduce biases induced by nonrandom treatment assignment.

We did not directly adjust for smoking status or borderline personality disorder, but imbalance in these variables across our 2 groups is likely reduced or eliminated because they are correlated with other variables (eg, age, sex, race/ethnicity, diabetes, and Diagnostic Cost Group) on which we did match patients. Evidence in support of this untestable assumption can be seen in Table 1 in our article in which many covariates (eg, marital status, coronary artery disease, alcohol abuse, and substance abuse) were well-balanced despite not matching on them.

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April 14, 2015
Sameer B. Murali, MD
1Department of Bariatric Medicine, Southern California Permanente Medical Group, Fontana
JAMA. 2015;313(14):1473-1474. doi:10.1001/jama.2015.2580.
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