Spine
SPINE Volume 39, Number 1, p 111 ©2013, Lippincott Williams & Wilkins
LETTERS Armando Romero Perez, MD, FAANS Section of Vascular and Spine Surgery, Department of Neurosurgery, Hospital Angeles de Puebla, Puebla, Mexico arromerez@hotmail. com
TO THE EDITOR Re: Fineberg SJ, Oglesby M, Patel AA, et al. Incidence and mortality of perioperative cardiac events in cervical spine surgery. Spine 2013;38:1268-74. ineberg et aP reported that diabetes and renal failure (markers of worse cardiovascular outcomes) were not identified as risk factors for cardiac complications after cervical spine surgery. Are patients with diabetes and chronic renal disease truly at lower risk of cardiovascular complications? Perhaps the analysis "missed the mark." Wimmer et aP compared the utility of these tests with randomized data. They found that their analysis contradicted randomized trial results, which made evident the inability of "modern" statistical methods to fully adjust for the measured patient differences. Observational studies drive clinical practice to a certain extent; however, they should be interpreted very cautiously and under the "hypothesis generating" dimension. Therefore, in the decision-making process, the results must be in line with the biological plausibility otherwise the clinical judgment should prevail due to a high risk of tuissing the mark because of the always hidden unmeasured confounders. We should recognize the danger of assuming that we can fully adjust for confounding factors in nonrandomized datasets even with "modern" statistical methods and acknowledge that randomized data can not be replaced. We think chnicians must still consider diabetes as a coronary artery disease equivalent and at higher risk of cardiac cornplications.
F
Ricardo O. Escárcega, MD Section of Cardiology, Washington Hospital Center, Washington, DC Nevin C. Baker, DO Section of Cardiology, Washington Hospital Center, Washington, DC Salvador Fuentes-Alexandro, MD Section of Geriatrics, Department of Internal Medicine, Hospital Angeles de Puebla, Mexico Marco A. Magalhaes, MD Section of Cardiology, Washington Hospital Center, Washington, DC References 1. Fineberg SJ, Oglesby M, Patel AA, et al. Incidence and mortality of perioperative cardiac events in cervical spine surgery. Spine 2013;38:1268-74. 2. Wimmer NJ, Resnic FS, Mauri L, et al. Comparison of transradial versus transfemoral percutaneous coronary intervention in routine practice: evidence for the importance of "falsification hypotheses" in observational studies of comparative effectiveness, [published online ahead of print August 08, 2013] / Am Coll Cardiol 2013.
The manuscript submitted does not contain information about medical device(s)/drug(s). No funds were received in support of this work. No relevant financial activities outside the submitted work. DOI: 10.1097/BRS.0000000000000032 Spine
www.spinejournal.com
111
Copyright of Spine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
SPINE Volume 39, Number 1, p 111 ©2013, Lippincott Williams & Wilkins
LETTERS Armando Romero Perez, MD, FAANS Section of Vascular and Spine Surgery, Department of Neurosurgery, Hospital Angeles de Puebla, Puebla, Mexico arromerez@hotmail. com
TO THE EDITOR Re: Fineberg SJ, Oglesby M, Patel AA, et al. Incidence and mortality of perioperative cardiac events in cervical spine surgery. Spine 2013;38:1268-74. ineberg et aP reported that diabetes and renal failure (markers of worse cardiovascular outcomes) were not identified as risk factors for cardiac complications after cervical spine surgery. Are patients with diabetes and chronic renal disease truly at lower risk of cardiovascular complications? Perhaps the analysis "missed the mark." Wimmer et aP compared the utility of these tests with randomized data. They found that their analysis contradicted randomized trial results, which made evident the inability of "modern" statistical methods to fully adjust for the measured patient differences. Observational studies drive clinical practice to a certain extent; however, they should be interpreted very cautiously and under the "hypothesis generating" dimension. Therefore, in the decision-making process, the results must be in line with the biological plausibility otherwise the clinical judgment should prevail due to a high risk of tuissing the mark because of the always hidden unmeasured confounders. We should recognize the danger of assuming that we can fully adjust for confounding factors in nonrandomized datasets even with "modern" statistical methods and acknowledge that randomized data can not be replaced. We think chnicians must still consider diabetes as a coronary artery disease equivalent and at higher risk of cardiac cornplications.
F
Ricardo O. Escárcega, MD Section of Cardiology, Washington Hospital Center, Washington, DC Nevin C. Baker, DO Section of Cardiology, Washington Hospital Center, Washington, DC Salvador Fuentes-Alexandro, MD Section of Geriatrics, Department of Internal Medicine, Hospital Angeles de Puebla, Mexico Marco A. Magalhaes, MD Section of Cardiology, Washington Hospital Center, Washington, DC References 1. Fineberg SJ, Oglesby M, Patel AA, et al. Incidence and mortality of perioperative cardiac events in cervical spine surgery. Spine 2013;38:1268-74. 2. Wimmer NJ, Resnic FS, Mauri L, et al. Comparison of transradial versus transfemoral percutaneous coronary intervention in routine practice: evidence for the importance of "falsification hypotheses" in observational studies of comparative effectiveness, [published online ahead of print August 08, 2013] / Am Coll Cardiol 2013.
The manuscript submitted does not contain information about medical device(s)/drug(s). No funds were received in support of this work. No relevant financial activities outside the submitted work. DOI: 10.1097/BRS.0000000000000032 Spine
www.spinejournal.com
111
Copyright of Spine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
