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Comment & Response |

Surgery and Neurodevelopmental Impairment—Reply

Abhik Das, PhD1; Shampa Saha, PhD2; Frank H. Morriss Jr, MD, MPH3
[+] Author Affiliations
1Social, Statistical, and Environmental Sciences Unit, RTI International, Rockville, Maryland
2Social, Statistical, and Environmental Sciences Unit, RTI International, Research Triangle Park, North Carolina
3Department of Pediatrics, University of Iowa, Iowa City
JAMA Pediatr. 2014;168(12):1169. doi:10.1001/jamapediatrics.2014.1787.
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In Reply We appreciate the careful reading of our article by Weisz et al recently published in JAMA Pediatrics, who point out that our propensity score calculations omit consideration of the timing of surgery, an important variable in adjusting for selection bias.1,2 While we have dates of occurrence for some of the morbidities that we adjusted for, the Neonatal Research Network Generic Database does not contain information on the timing of surgery for the birth years 1998 to 2009. Consequently, there is essentially no precise way to know whether surgery predated some of the morbidities and we cannot do the type of time-aware propensity analysis that Weisz et al suggest. However, if anything, we may have adjusted for more covariates than we should have (ie, for morbidities that followed surgery); therefore, our results are more likely to be biased toward the null because of overadjustment. Nonetheless, we still found a sizeable and statistically significant association between surgery and outcome. This attests to the robustness of the effect and makes it more likely that we observed a true association, although we may have underestimated its magnitude because of overadjustment.

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December 1, 2014
Dany E. Weisz, MD; Lucia Mirea, PhD; Prakesh S. Shah, MD, MSc
1Department of Newborn and Developmental Pediatrics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
2Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
3Department of Pediatrics, Mt Sinai Hospital, Toronto, Ontario, Canada
JAMA Pediatr. 2014;168(12):1168-1169. doi:10.1001/jamapediatrics.2014.1781.
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