In Reply We appreciate the comments by Pal and understand the quandary in trying to generalize our study.1 Pal’s comments concerning age, surgery risk, type of anesthetic drug, or phenotype certainly point to the evidence that postoperative delirium is a complicated geriatric syndrome and that many factors weigh into its causation. Many of the factors mentioned should be the focus of future studies in this area to help enhance our understanding and improve management. From our study design, we cannot comment on surgical risk or other anesthetic drugs. However, in this randomized clinical trial, in an older population undergoing hip fracture repair, lighter propofol sedation was not found to decrease the incidence of postoperative delirium except in a subgroup of patients with lower comorbidity.1 All of the modeling approaches for delirium analysis accounted for age. The data suggest, as does Pal, that patient phenotype, particularly underlying comorbid state, and clinical factors, such as depth of sedation, may play more complex roles in the risk of postoperative delirium than simply instilling their individual direct effects toward this complicated geriatric syndrome.
Identify all potential conflicts of interest that might be relevant to your comment.
Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.
Err on the side of full disclosure.
If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.
Not all submitted comments are published. Please see our commenting policy for details.
Sieber F, Wang N. Postoperative Delirium—Amplifying the Confusion—Reply. JAMA Surg. Published online January 16, 2019154(4):366. doi:10.1001/jamasurg.2018.5245
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: