Critical Flaws in a Recent JACS Publication Describing Trajectories of Postoperative Recovery

Kahlil et al.'s recent article 1 describing trajectories of days elsewhere than home, published in this Journal, replicates our prior study reported in JAMA Surgery 2 describing perioperative trajectories in the Veterans Health Administration (VHA).The authors neither acknowledged nor discussed key differences in data sources and findings between our original study and their new analysis.For example, because Medicare does not typically pay for long-term care, the data used by Khalil et al. do not appear to include individuals with long-term admissions to nursing homes.Therefore, the trajectory they labeled as "Chronic Dependence" is misleading and inaccurate, representing a population with only 3-4 days/ month elsewhere than home.By contrast our analysis merged data from the VHA, Medicare, Medicaid and most pertinently, the Minimum Data Set to describe a trajectory of Chronic Dependence with 25-30 days/month elsewhere than home.Similar substantive differences are observed in the trajectories they nonetheless label with terms identical to those used