Family Visiting Restrictions and Postoperative Clinical Outcomes: A Retrospective Analysis
Round 1
Reviewer 1 Report
This research manuscript describes a retrospective study to determine differences between post-operative older adult patients: 1. those who had surgery before the pandemic and therefore were allowed to have family caregivers present as a support and 2. those who had surgery during the pandemic and therefore were not allowed to have family support present with them. I very much agree with the hypothesis of this work--that patients do better if they can have their family members present during medical care. Some modifications to the paper are needed to make it ready for publication.
1. With this being a retrospective study with relatively few patients, it should be made clear that causation can not be implied or taken away from this. It is possible that there were other factors that were different between the two time periods of comparison besides family members presence that could have contributed to differences. For example, the presence of all healthcare workers wearing masks and therefore being potentially more difficult to hear/understand and appearing potentially more frightening; or changes in staffing ratios, etc.
2. Were all the surgeries scheduled/planned surgeries or were some of the surgeries emergency surgeries? If so then that would be worth listing for a point of comparison in your table 1.
3. In table 1, please describe what is meant by “exposed” and “unexposed” so that table 1 can stand alone.
4. Page 4 Line 114-115 “quality of such surveillance can be considered higher as compared to that provided by nurses” This is a very strong statement that seems to need a reference
5. Just an additional comment about your discussion on page 4 lines 118-128, The psychic pain of missing family members could amplify the somatic pain.
Author Response
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Author Response File: 
Author Response.pdf
Reviewer 2 Report
Thank you for the opportunity to review this paper. The paper sought to report the effects of family visiting restrictions on postoperative clinical outcomes.
The introduction is too brief to provide sufficient background for the study. Please discuss clearly the significance of the study. In the results part, there are some differences from table 1. Please check the data. In the introduction, length of stay is a positive outcome with FRs presence. How about the length of stay? The length of stay in those patients who were not allowed to receive FRs visits were less (LOS 6.2 days, SD= 3.3 vs. 6.6 days, SD = 4.4; p=0.096) as compared to unexposed, although there is no statistical differences between exposed and unexposed emerged.
Author Response
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Reviewer 3 Report
This is a retrospective study of patient care outcomes associated with exposure to the hospital visiting program. The central thesis is that patient-centered care is invaluable in providing effective hospital care. The retrospective analysis has adequately addressed the general issue pertaining to the protective effect of patient-centered care. There are two critical issues that need to be discussed carefully, however.
First, the paper has to clarify the retrospective (case-control) vs. the prospective (cohort or population-based) study design. Did you conduct the propensity score and matching analysis since your study is a retrospective study design, not a cohort or prospective study design.
Second, the limitations of the study should be expanded. You need to enumerate a number of methodological limitations and present how future research could be systematically studied.
In conclusion, the paper needs to be amended before it is ready for publication.
Author Response
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Author Response File: Author Response.pdf
Round 2
Reviewer 2 Report
Thank you for the opportunity to review this paper. the revised manuscript is better than before. The sequence of the references is needed.
Author Response
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Author Response File: 
Author Response.doc
Reviewer 3 Report
Overall, this is an improved version of a scientific study. Careful inspection shows that the authors are not responsive to some items (10, 13, 16). If no changes or improvements were made, it is also necessary to document how future research could improve the design and analysis of data. In most cases, the authors could also note the limitations. For instance, the lack of sample size justification and failure to perform sensitivity analysis could be the limitations. The importance is to show how future research could be performed to avoid any biases.
Author Response
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Author Response File: Author Response.doc
