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Comment & Response
April 4, 2019

Daytime Sleepiness and Surgical Skill—Reply

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 2Facial Plastic SurgiCenter, Baltimore, Maryland
  • 3Malone Center for Engineering in Healthcare, Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland
JAMA Facial Plast Surg. 2019;21(4):344. doi:10.1001/jamafacial.2018.2043

In Reply We appreciate the interest shown by Ori et al in our article.1 It seems to us that the criticisms about ambiguities in our study being misleading are unfounded and unsubstantiated. First, our conclusions in the article are clear about their relevance to daytime sleepiness within the range observed in our study. Second, it is unclear to us what statistical biases are introduced by a study population comprising residents at different levels of training, which Ori et al mention in their letter. We would appreciate clarification on the source of bias in this context and its presumed direction. Third, we used statistical methods appropriate for our study design, specifically, generalized estimating equations to allow inferences despite differences in number of procedures performed by trainees. We refer Ori et al to a standard source for details of the statistical methods used in our article.2 Fourth, we explicitly reported in the article that our study did not involve evaluating the association of surgeons’ daytime sleepiness with patient outcomes. However, we are grateful to Ori et al for their specific suggestions on relevant outcomes.