We thank Dr Pagona Koukiasa and Dr Antonio M. Esquinas for their comments on our recent report.1
In our article, Table 1 shows that 14.9% (462/3093) of the study patients were classified into the high-risk group, with American Society of Anesthesiologists’ physical status (ASA-PS) ≥3.2 Among patients in the ASA-PS ≥3 group, 1.5% (7/462) had life-threatening complications. Most of the patients who had suffered from life-threatening complications were those with ASA-PS 1 or 2 (82.5%, 33/40).
In our cohort, risk assessment with ASA-PS was not related to life-threatening complications, which was inconsistent with previous knowledge.2,3 The low reliability of the ASA-PS classification in our database might have had some influence on this issue as we have discussed in our article.2 Unfortunately, we did not have data on surgical procedures. It would have been preferable to consider certain issues in our analyses, such as procedures that were changed during surgery from those that were scheduled and the severity of the procedures. Also, we did not have documentation regarding the clinical decision to extubate; thus inappropriately early extubation might have contributed to the outcome as Koukiasa and Esquinas are pointing out. As we have mentioned in the discussion, these are inherent limitations of our retrospective observational study that could not be addressed.
We agree with Koukiasa and Esquinas that fluid overload needs to be further investigated as a harmful factor in surgical patients, and we hope further research on intermediate care units will follow.
Acknowledgements relating to this article
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1. Koukiasa P, Esquinas AM. Postoperative intermediate care unit and life-threatening complications: how much and how are they linked? Eur J Anaesthesiol
2. Fujii T, Uchino S, Takinami M. Life-threatening complications after postoperative intermediate care unit discharge: a retrospective, observational study. Eur J Anaesthesiol
3. Donati A, Ruzzi M, Adrario E, et al. A new and feasible model for predicting operative risk. Br J Anaesth