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Comment & Response
May 19, 2021

To Perform or Not to Perform Surgery for Frail Patients?—Reply

Author Affiliations
  • 1Division of Vascular Surgery, Stanford University School of Medicine, Stanford, California
  • 2Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
JAMA Surg. 2021;156(9):891-892. doi:10.1001/jamasurg.2021.1531

In Reply As Goto accurately notes, the registries used in our analysis1 do not quantify frailty-informed modifications of surgical plans, and as such, it is not possible to control for this potential source of bias. Yet, our findings show a consistent signal of higher mortality across all procedure types, especially among lower-stress procedures, and across all specialties; no specialty is exempt from the effects of frailty. As Goto suggests, the unmeasured bias would likely attenuate rather than augment the association between frailty and mortality, further reinforcing that there is no such thing as minor surgery for frail patients.

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