The Use of Racial and Ethnic Terms

Abstract

In Reply We appreciate the interest shown by Ori et al in our article. 1 It seems to us that the criticisms about ambiguities in our study being misleading are unfounded and unsubstantiated. First, our conclusions in the article are clear about their relevance to daytime sleepiness within the range observed in our study. Second, it is unclear to us what statistical biases are introduced by a study population comprising residents at different levels of training, which Ori et al mention in their letter. We would appreciate clarification on the source of bias in this context and its presumed direction. Third, we used statistical methods appropriate for our study design, specifically, generalized estimating equations to allow inferences despite differences in number of procedures performed by trainees. We refer Ori et al to a standard source for details of the statistical methods used in our article. 2 Fourth, we explicitly reported in the article that our study did not involve evaluating the association of surgeons' daytime sleepiness with patient outcomes. However, we are grateful to Ori et al for their specific suggestions on relevant outcomes.Finally, on behalf of our clinical coauthors, we note the following: it is unclear to us what is unique about the quick septoplasty technique. To our knowledge, limited elevation on the opposite side of the septum and cross-septal sutures described as part of the quick septoplasty technique are not new. Additionally, we find it difficult to understand how a quick technique or the speed of surgery alone mitigates the effect of fatigue or sleepiness on surgeons' performances, particularly when septoplasty is often accompanied with other procedures such as rhinoplasty. Furthermore, the purpose of septoplasty is not the removal of septal cartilage or reshaping the septum. It is to improve the subjective experience of nasal breathing. To this end, surgery for nasal obstruction often does not lend itself to a specific repeatable technique, and instead involves technical adaptations to reconcile subjective experience of patients with objective findings on examination. So we are unable to understand how any single technique offers something of value across the entire patient population. We did not restrict our study to any particular technique of septoplasty.