Response to “Comments on ‘Added Healthcare Charges Conferred by Smoking in Outpatient Plastic Surgery’”

Response to “Comments on ‘Added Healthcare Charges Conferred by Smoking in Outpatient Plastic... Thank you for your interest1 in our recent publication entitled “Added Healthcare Charges Conferred by Smoking in Outpatient Plastic Surgery.”2 The use of administrative data from sources such as the Healthcare Cost and Utilization Project (HCUP) database to study large and heterogeneous groups of patients is growing in utility and popularity. There are, however, limitations to the use of this type of data which restricts our ability to address some of the concerns posed in a recent Letter to the Editor.1 It is well known that operative time impacts postoperative outcomes, and we agree that including operative time in our analysis would add important information to our evaluation of postsurgical patients. However, the variable “operating time” is only available from the New York State Ambulatory Surgery Center Database, which is only a fraction of our total sample. Furthermore, the “operating time” variable is defined as the total time in the operating room, not solely the time under anesthesia or the time from Incision to close. Because of these limitations, we did not use this variable in our analysis. We appreciate the questions regarding the specifics of our model construction and model diagnostics. Prior to entering variables in the models, a spearman correlation matrix was used to determine whether variables were correlated and, if so, the strength of this correlation. While we found some variables were significantly correlated, the strength of the correlation was weak and unlikely to substantially influence the results. Regarding the models, the c-statistics ranged from 0.587 to 0.731 with most models showing a higher c-statistic for the complication model than for the hospital-based acute care model. To provide additional transparency, a full correlation matrix has been provided (Appendix A), as well as the specific c-statistics for each model individually (Appendix B). Lastly, the effect of preoperative smoking cessation on surgical outcomes is an important issue, but it is not one that can be addressed with the current dataset. We raise this same issue in our discussion. In an effort to not mislead the reader, we worded our paper to highlight this limitation both in the way we referred to the patient’s smoking status without further stratification, and directly in the paper’s methods and limitations paragraph. When using administrative data of this kind, the researcher often trades granularity of data for other benefits. In this study, no variables or administrative codes existed which could accurately define how substantial the patient’s history of smoking was (ie, ½ pack per day vs 3 packs per day), if they stopped prior to surgery, and if so, how far in advance. This is most certainly an area in need of further study. Thank you again for your interest in our research, we hope this response adequately answers the questions that have been posed. Supplementary Material This article contains supplementary material located online at www.aestheticsurgeryjournal.com. Disclosures The authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article. Funding The authors received no financial support for the research, authorship, and publication of this article. Disclaimers The views expressed in this article are those of the authors and do not reflect the official policy of the United States Air Force, Department of Defense, or the US Government. REFERENCES 1. Kendall MC, Castro-Alves LJ. Comments on ‘Added Healthcare Charges Conferred by Smoking in Outpatient Plastic Surgery’”. Aesthet Surg J . 2018;38(7):NP106-NP106. 2. Sieffert MR, Johnson RM, Fox JP. Added healthcare charges conferred by smoking in outpatient plastic surgery. Aesthet Surg J . 2018; doi: 10.1093/asj/sjx231. [ePub ahead of print] © 2018 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Aesthetic Surgery Journal Oxford University Press

Response to “Comments on ‘Added Healthcare Charges Conferred by Smoking in Outpatient Plastic Surgery’”

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Publisher
Oxford University Press
Copyright
© 2018 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com
ISSN
1090-820X
eISSN
1527-330X
D.O.I.
10.1093/asj/sjy090
Publisher site
See Article on Publisher Site

Abstract

Thank you for your interest1 in our recent publication entitled “Added Healthcare Charges Conferred by Smoking in Outpatient Plastic Surgery.”2 The use of administrative data from sources such as the Healthcare Cost and Utilization Project (HCUP) database to study large and heterogeneous groups of patients is growing in utility and popularity. There are, however, limitations to the use of this type of data which restricts our ability to address some of the concerns posed in a recent Letter to the Editor.1 It is well known that operative time impacts postoperative outcomes, and we agree that including operative time in our analysis would add important information to our evaluation of postsurgical patients. However, the variable “operating time” is only available from the New York State Ambulatory Surgery Center Database, which is only a fraction of our total sample. Furthermore, the “operating time” variable is defined as the total time in the operating room, not solely the time under anesthesia or the time from Incision to close. Because of these limitations, we did not use this variable in our analysis. We appreciate the questions regarding the specifics of our model construction and model diagnostics. Prior to entering variables in the models, a spearman correlation matrix was used to determine whether variables were correlated and, if so, the strength of this correlation. While we found some variables were significantly correlated, the strength of the correlation was weak and unlikely to substantially influence the results. Regarding the models, the c-statistics ranged from 0.587 to 0.731 with most models showing a higher c-statistic for the complication model than for the hospital-based acute care model. To provide additional transparency, a full correlation matrix has been provided (Appendix A), as well as the specific c-statistics for each model individually (Appendix B). Lastly, the effect of preoperative smoking cessation on surgical outcomes is an important issue, but it is not one that can be addressed with the current dataset. We raise this same issue in our discussion. In an effort to not mislead the reader, we worded our paper to highlight this limitation both in the way we referred to the patient’s smoking status without further stratification, and directly in the paper’s methods and limitations paragraph. When using administrative data of this kind, the researcher often trades granularity of data for other benefits. In this study, no variables or administrative codes existed which could accurately define how substantial the patient’s history of smoking was (ie, ½ pack per day vs 3 packs per day), if they stopped prior to surgery, and if so, how far in advance. This is most certainly an area in need of further study. Thank you again for your interest in our research, we hope this response adequately answers the questions that have been posed. Supplementary Material This article contains supplementary material located online at www.aestheticsurgeryjournal.com. Disclosures The authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article. Funding The authors received no financial support for the research, authorship, and publication of this article. Disclaimers The views expressed in this article are those of the authors and do not reflect the official policy of the United States Air Force, Department of Defense, or the US Government. REFERENCES 1. Kendall MC, Castro-Alves LJ. Comments on ‘Added Healthcare Charges Conferred by Smoking in Outpatient Plastic Surgery’”. Aesthet Surg J . 2018;38(7):NP106-NP106. 2. Sieffert MR, Johnson RM, Fox JP. Added healthcare charges conferred by smoking in outpatient plastic surgery. Aesthet Surg J . 2018; doi: 10.1093/asj/sjx231. [ePub ahead of print] © 2018 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)

Journal

Aesthetic Surgery JournalOxford University Press

Published: May 23, 2018

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