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Addressing the longitudinal components of surgical treatments

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Abstract

Despite their pre- and postoperative components, surgical treatment strategies have typically been cast as point interventions in causal inference research. When longitudinal perioperative components affect outcomes of interest, leaving them unspecified or failing to measure adherence to them complicates the interpretation of effect estimates. Inspired by two recent landmark trials that assessed the risk of stroke or death after transcatheter aortic valve replacement (TAVR) compared with surgical aortic valve replacement (SAVR), the PARTNER 3 trial and the Evolut Low Risk trial, we discuss possible ways that different postoperative therapies in treatment arms and incomplete adherence to those therapies can impact the interpretation of intention-to-treat effect estimates in surgical trials. We argue that surgical treatments are not necessarily point interventions, and make recommendations for improving the design and analysis of trials involving surgical interventions. Central to these recommendations is the need for investigators to specify and report adherence to longitudinal perioperative treatment components.

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Funding

Author C.M. was supported by award Number T32GM144273 from the National Institute of General Medical Sciences. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of General Medical Sciences or the National Institutes of Health. The remaining authors declare that they received no funds, grants, or other support during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA

    Chelsea J. Messinger, Arin L. Madenci & Kerollos Nashat Wanis

  2. Harvard/MIT M.D.-Ph.D. Program, Harvard Medical School, Boston, MA, USA

    Chelsea J. Messinger

  3. Department of Surgery, Boston Children’s Hospital, Boston, MA, USA

    Arin L. Madenci

  4. Department of Surgery, Western University, London, ON, Canada

    Kerollos Nashat Wanis

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  1. Chelsea J. Messinger
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  2. Arin L. Madenci
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  3. Kerollos Nashat Wanis
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Contributions

All authors contributed to the conception of the intellectual content presented in this commentary. The first draft of the manuscript was written by author C.M. and all authors significantly contributed to subsequent versions. All authors read and approved of the final manuscript.

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Correspondence to Chelsea J. Messinger.

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Messinger, C.J., Madenci, A.L. & Wanis, K.N. Addressing the longitudinal components of surgical treatments. Eur J Epidemiol 38, 1019–1023 (2023). https://doi.org/10.1007/s10654-023-01045-w

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  • DOI: https://doi.org/10.1007/s10654-023-01045-w

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