We thank Drs. Kumar and Jain1 for their interest in our study2 on the association between intraoperative use of phenylephrine, compared to ephedrine, and delirium after noncardiac surgery under general anesthesia.
We appreciate the authors’ remarks emphasizing the importance of our secondary and sensitivity analyses from a clinical perspective: Drs. Kumar and Jain raise concerns about variability in provider choice of phenylephrine versus ephedrine. In our institutions as in many others, some providers may use ephedrine, and others use phenylephrine as their “weapon of choice” when treating hypotension. We have emphasized this in our secondary analysis investigating provider variability in vasopressor preference—adding the primary anesthesia provider as a random effect in a mixed-effects logistic regression model did not alter the primary findings. To further characterize provider variability, we have now used random-effect variances and model residuals to calculate intraclass correlation. This measure quantifies variability in the use of...
