To the Editor:—  I read with interest the article by Kheterpal et al.  1However, I am concerned that they did not control for hypothermia in their analysis. Hypothermia is considered to be a risk factor for morbid cardiac events.2,3Without controlling for this variable, the risk assigned to their nine variables may be different than what was reported. For example, suppose the elderly patients became hypothermic more readily than the nonelderly patients. If this was the case, then the risk factor of being elderly may be overestimated, as it could have been the hypothermia and not the age that caused the problem in the elderly patient. I suspect that accurate core temperatures were not measured in most, if not all, patients who did not receive general anesthesia. However, the study population seems large enough to allow for a separate analysis of patients who did have their core temperature recorded. Do the authors have any temperature analysis that was not reported in the article?

Albert Einstein Medical Center, Philadelphia, Pennsylvania.


Kheterpal S, O'Reilly M, Englesbe MJ, Rosenberg AL, Shanks AM, Zhang L, Rothman ED, Campbell DA, Tremper KK: Preoperative and intraoperative predictors of cardiac adverse events after general, vascular, and urological surgery. Anesthesiology 2009; 110:58–66
Sessler DI: Temperature monitoring and perioperative thermoregulation. Anesthesiology 2008; 109:318–38
Frank SM, Fleisher LA, Breslow MJ, Higgins MS, Olson KF, Kelly S, Beattie C: Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events: A randomized clinical trial. JAMA 1997; 277:1127–34