We appreciate the comments from Zhang et al. on our recent article “Delirium in Older Patients after Combined Epidural–General Anesthesia or General Anesthesia for Major Surgery: A Randomized Trial.”

Consistent with many others, our study also found that intraoperative hypotension occurred more frequently in patients given combined epidural–general anesthesia. Increasing evidence suggests that intraoperative hypotension is associated with an increased risk of postoperative delirium.4,5  According to the suggestion of Zhang et al., we included intraoperative hypotension in a post hoc treatment-by-covariate interaction analysis for the primary outcome. Our results did not find significant interaction between treatment intervention and intraoperative hypotension. The effect of combined epidural–general anesthesia on delirium was similar in the subgroups with or without intraoperative hypotension (with intraoperative hypotension [systolic blood pressure < 80 mmHg]: relative risk 0.68; 95% CI, 0.20 to 2.37; without intraoperative hypotension: 0.33, 0.16 to 0.67;...

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