We thank Suzuki et al. for their interest in our recent work and would like to address their concerns. The challenge of combining patients of different study protocols spanning several years is a potential bias we noted ourselves. However, the single-center setting means that investigators and surgeons remained the same and the highly elective patients for bariatric surgery only were treated according to clinical standards which remained unchanged during the time. It seems unlikely that positive end-expiratory pressure (PEEP)–dependent physiologic effects were influenced by any minor change over time. Moreover, randomization guarantees that differences within each study are the result of chance alone, and the difference in ARISCAT (Assess Respiratory rIsk in Surgical patients in CATalonia) scores between the groups are both clearly presented and not in the least indicative of a meaningful imbalance in...

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