Title: Impact of atherosclerosis on the postoperative complications of colorectal surgery in older
patients with colorectal cancer
Version: 1 Date: 26 Sep 2022
Reviewer's report:
Short summary: This is an interesting single-center study where the authors investigate whether
atherosclerosis is associated with postoperative complications of Clavien-Dindo complication
grade 3 or higher.
Major comments:
- It is mentioned several times that CAVI and AAC are 'independent' risk factors for
postoperative complications. In statistics, an independent risk factor should be part of a model
with established risk factors, however you performed only univariate logistic regression on few
parameters. In order to confirm CAVI and AAC as an independent risk factor, a multivariate
model including the risk factors you describe in the discussion (line 188-190, of which many
could be confounders as i.e. smoking, sex and diabetes are associated with athersclerosis) would
need to be part of the model. A model including these, as well as ASA score, hyperlipidemia,
hypertension, ischemic heart disease etc would be very interesting, to see whether CAVI and
AAC would still hold up as independent risk factors.
Otherwise, you might want to amend your description of an 'independent risk factor'.
- The authors conclude (line 253-256) that preoperative atherosclerosis evaluation could help
surgeons perform surgery safely and appropriately tailor postoperative management. While this
may be true, there is nothing in the discussion where it is mentioned how measuring CAVI and
AAC might influence changes in treatment. The atherosclerosis itself is not treatable anymore.
Would you suggest all patients with results over the ROC-cutoff get a stoma? Should they not
undergo surgery? I would reccommend adding to the discussion what the clinical implication
is of doing these measurements.
Minor comments:
- A mean postoperative stay of 16 days +/- 23 days seems very long for colorectal surgery,
especially if this is only elective surgeries. Please discuss this.
- Line 198 - you write that postoperative complications might be caused by atherosclerosis. As
this is an observational study, you might refrain from inferring causation and rather talk about
an 'association' between atherosclerosis and postoperative complications.
Title: Impact of atherosclerosis on the postoperative complications of colorectal surgery in older
patients with colorectal cancer
Version: 1 Date: 26 Sep 2022
Reviewer's report:
Short summary: This is an interesting single-center study where the authors investigate whether
atherosclerosis is associated with postoperative complications of Clavien-Dindo complication
grade 3 or higher.
Major comments:
- It is mentioned several times that CAVI and AAC are 'independent' risk factors for
postoperative complications. In statistics, an independent risk factor should be part of a model
with established risk factors, however you performed only univariate logistic regression on few
parameters. In order to confirm CAVI and AAC as an independent risk factor, a multivariate
model including the risk factors you describe in the discussion (line 188-190, of which many
could be confounders as i.e. smoking, sex and diabetes are associated with athersclerosis) would
need to be part of the model. A model including these, as well as ASA score, hyperlipidemia,
hypertension, ischemic heart disease etc would be very interesting, to see whether CAVI and
AAC would still hold up as independent risk factors.
Otherwise, you might want to amend your description of an 'independent risk factor'.
- The authors conclude (line 253-256) that preoperative atherosclerosis evaluation could help
surgeons perform surgery safely and appropriately tailor postoperative management. While this
may be true, there is nothing in the discussion where it is mentioned how measuring CAVI and
AAC might influence changes in treatment. The atherosclerosis itself is not treatable anymore.
Would you suggest all patients with results over the ROC-cutoff get a stoma? Should they not
undergo surgery? I would reccommend adding to the discussion what the clinical implication
is of doing these measurements.
Minor comments:
- A mean postoperative stay of 16 days +/- 23 days seems very long for colorectal surgery,
especially if this is only elective surgeries. Please discuss this.
- Line 198 - you write that postoperative complications might be caused by atherosclerosis. As
this is an observational study, you might refrain from inferring causation and rather talk about
an 'association' between atherosclerosis and postoperative complications.
Please review this paper.
user
Title: Impact of atherosclerosis on the postoperative complications of colorectal surgery in older
patients with colorectal cancer
Version: 1 Date: 26 Sep 2022
Reviewer's report:
Short summary: This is an interesting single-center study where the authors investigate whether
atherosclerosis is associated with postoperative complications of Clavien-Dindo complication
grade 3 or higher.
Major comments:
- It is mentioned several times that CAVI and AAC are 'independent' risk factors for
postoperative complications. In statistics, an independent risk factor should be part of a model
with established risk factors, however you performed only univariate logistic regression on few
parameters. In order to confirm CAVI and AAC as an independent risk factor, a multivariate
model including the risk factors you describe in the discussion (line 188-190, of which many
could be confounders as i.e. smoking, sex and diabetes are associated with athersclerosis) would
need to be part of the model. A model including these, as well as ASA score, hyperlipidemia,
hypertension, ischemic heart disease etc would be very interesting, to see whether CAVI and
AAC would still hold up as independent risk factors.
Otherwise, you might want to amend your description of an 'independent risk factor'.
- The authors conclude (line 253-256) that preoperative atherosclerosis evaluation could help
surgeons perform surgery safely and appropriately tailor postoperative management. While this
may be true, there is nothing in the discussion where it is mentioned how measuring CAVI and
AAC might influence changes in treatment. The atherosclerosis itself is not treatable anymore.
Would you suggest all patients with results over the ROC-cutoff get a stoma? Should they not
undergo surgery? I would reccommend adding to the discussion what the clinical implication
is of doing these measurements.
Minor comments:
- A mean postoperative stay of 16 days +/- 23 days seems very long for colorectal surgery,
especially if this is only elective surgeries. Please discuss this.
- Line 198 - you write that postoperative complications might be caused by atherosclerosis. As
this is an observational study, you might refrain from inferring causation and rather talk about
an 'association' between atherosclerosis and postoperative complications.
assistant