In Reply We appreciate the thoughtful questions raised in response to our retrospective cohort1 examining the association of preoperative frailty measured by the Risk Analysis Index and operative stress measured by the Operative Stress Score with postoperative mortality. Han et al raise several concerns that limit generalizability of our study: (1) exclusion of cardiac procedures, (2) underrepresentation of women, (3) lack of consideration of case status, and (4) limitations to the Delphi methodology. Regarding the first critique, we used the Veterans Administration Surgical Quality Improvement Program (VASQIP), which collects data on cardiac procedures separately from noncardiac procedures. The cardiac registry lacks the variables needed to estimate frailty using the Risk Analysis Index. We agree that analyses of cardiac patients should be pursued with other data sources.
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Shinall MC, Shireman PK, Hall DE. Implications of Preoperative Patient Frailty on Stratified Postoperative Mortality—Reply. JAMA Surg. Published online April 22, 2020. doi:10.1001/jamasurg.2020.0431
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