We appreciate Leslie et al.’s interest in our recent single-center retrospective registry analysis of postoperative complications after neuromuscular blockade with neostigmine versus sugammadex, and we certainly agree that a large randomized controlled trial would be beneficial in further elucidating the mixed results that have been published to date. We also agree that, ideally, retrospective studies should only use endpoints that were directly related to the condition or intervention under study, and that those endpoints should not be influenced by other factors. However, in constructing a retrospective study, one is immediately confronted with the problems of data availability and data quality and with the reality that all clinical endpoints are invariably influenced by multiple overlapping processes.

We chose to use a subset of outcomes, as defined by the American College of Surgeons’ (Chicago, Illinois) National Surgical...

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