Annals of Surgery Volume 265, Number 5, May 2017
the main purpose of this study was to clarify the roles of organ failure and infection in the outcome of necrotizing pancreatitis, we invite the authors to conduct similar studies for further research. Disclosure: The authors declare no conflicts of interest. Qiang Guo, MD Weiming Hu, MD Pancreatic Surgery West China Hospital, Sichuan University Chengdu, Sichuan Province, China [email protected]
REFERENCES 1. Guo Q, Li A, Xia Q, et al. The role of organ failure and infection in necrotizing pancreatitis: a prospective study. Ann Surg. 2014;259:1201–1207. 2. Mounzer R, Langmead CJ, Wu BU, et al. Comparison of existing clinical scoring systems to predict persistent organ failure in patients with acute pancreatitis. Gastroenterology. 2012;142: 1476–1482. 3. Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013;13:1–15. 4. van Santvoort HC, Besselink MG, Bakker OJ, et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med. 2010;362:1491–1502. 5. Bakker OJ, van Santvoort HC, van Brunschot S, et al. Endoscopic transgastric vs surgical necrosectomy for infected necrotizing pancreatitis: a randomized trial. JAMA. 2012;307:1053–1061.
Preoperative Aspirin-dosing Strategy and Mortality After Coronary Artery Bypass Graft Surgery To the Editor: n a retrospective analysis assessing association between preoperative aspirin dosing strategy and 30-day all-cause mortality after coronary artery bypass graft (CABG) surgery, Deng and colleagues1 showed that low-dose aspirin use within 24 hours of CABG surgery was independently associated with decreased early postoperative mortality. Strengths of this study include a large sample of patients, with multivariable and propensity matching analyses to adjust influences of potential
I
ß
confounders on study endpoints. Other than the limitations described in the discussion, however, we note other issues of this study making interpretation of their results questionable. First, the perioperative hemoglobin levels were not provided, though they are routinely monitored in cardiac surgical patients. It has been shown that preoperative anemia is common among patients undergoing CABG surgery and is an important risk factor for early and late mortality.2,3 Furthermore, the combined mortality risk of anemia and transfusion is nearly triple that of a nonanemic patient not receiving transfusion.2 Similarly, hemodilution anemia (a hematocrit of
the main purpose of this study was to clarify the roles of organ failure and infection in the outcome of necrotizing pancreatitis, we invite the authors to conduct similar studies for further research. Disclosure: The authors declare no conflicts of interest. Qiang Guo, MD Weiming Hu, MD Pancreatic Surgery West China Hospital, Sichuan University Chengdu, Sichuan Province, China [email protected]
REFERENCES 1. Guo Q, Li A, Xia Q, et al. The role of organ failure and infection in necrotizing pancreatitis: a prospective study. Ann Surg. 2014;259:1201–1207. 2. Mounzer R, Langmead CJ, Wu BU, et al. Comparison of existing clinical scoring systems to predict persistent organ failure in patients with acute pancreatitis. Gastroenterology. 2012;142: 1476–1482. 3. Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013;13:1–15. 4. van Santvoort HC, Besselink MG, Bakker OJ, et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med. 2010;362:1491–1502. 5. Bakker OJ, van Santvoort HC, van Brunschot S, et al. Endoscopic transgastric vs surgical necrosectomy for infected necrotizing pancreatitis: a randomized trial. JAMA. 2012;307:1053–1061.
Preoperative Aspirin-dosing Strategy and Mortality After Coronary Artery Bypass Graft Surgery To the Editor: n a retrospective analysis assessing association between preoperative aspirin dosing strategy and 30-day all-cause mortality after coronary artery bypass graft (CABG) surgery, Deng and colleagues1 showed that low-dose aspirin use within 24 hours of CABG surgery was independently associated with decreased early postoperative mortality. Strengths of this study include a large sample of patients, with multivariable and propensity matching analyses to adjust influences of potential
I
ß
confounders on study endpoints. Other than the limitations described in the discussion, however, we note other issues of this study making interpretation of their results questionable. First, the perioperative hemoglobin levels were not provided, though they are routinely monitored in cardiac surgical patients. It has been shown that preoperative anemia is common among patients undergoing CABG surgery and is an important risk factor for early and late mortality.2,3 Furthermore, the combined mortality risk of anemia and transfusion is nearly triple that of a nonanemic patient not receiving transfusion.2 Similarly, hemodilution anemia (a hematocrit of
