To the Editor Dr Sun and colleagues1 performed a large database analysis of 66 430 overlapping surgical procedures. However, the challenges of large database studies include insufficiently granular data that may affect interpretation of the results.
The inclusion of THAs and spine procedures in the absence of diagnosis raises some concerns. It appears that the authors did not risk-adjust or differentiate cases based on the indication for surgery. For instance, THAs are increasingly being performed for hip fractures, and recent research has shown that THAs performed for a fracture have higher rates of postoperative complications and different resource utilization needs compared with THAs performed for hip osteoarthritis.2
Malik AT, Quatman CE, Strassels S. Outcomes Associated With Overlapping Surgery. JAMA. 2019;322(3):274–275. doi:10.1001/jama.2019.6463
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