Overestimation of the Causal Effects of Medications on Delirium During Postoperative Hospital Days

In Response

“…We thank Drs Hindman and Dexter 1 for their interest in our recent publication characterizing the associations between perioperative medication use and postoperative delirium and long-term cognitive impairment among older adults using the Successful Aging After Elective Surgery (SAGES) cohort. 2 The authors raise a number of interesting points regarding our analytic structure and the temporality of assessments that deserve close consideration in an effort to help readers interpret and apply our results.…”

“…2 Through post hoc discussion, we thought there might be value in exploring the differential effect of IV (versus oral) opioid use on delirium occurrence. As Drs Hindman and Dexter 1 note, the decision to use a specific route of opioid administration is made by the bedside clinician and accounts for a number of potential factors (eg, the desired time to first opioid effect and a patient’s tolerability to the oral route). Therefore, we agree that these results are subject to potential confounding by indication.…”