An Introduction to Causal Diagrams for Anesthesiology Research.

Abstract:

:Making good decisions in the era of Big Data requires a sophisticated approach to causality. We are acutely aware that association ≠ causation, yet untangling the two remains one of our greatest challenges. This realization has stimulated a Causal Revolution in epidemiology, and the lessons learned are highly relevant to anesthesia research. This article introduces readers to directed acyclic graphs; a cornerstone of modern causal inference techniques. These diagrams provide a robust framework to address sources of bias and discover causal effects. We use the topical question of whether anesthetic technique (total intravenous anesthesia vs. volatile) affects outcome after cancer surgery as a basis for a series of example directed acyclic graphs, which demonstrate how variables can be chosen to statistically control confounding and other sources of bias. We also illustrate how controlling for the wrong variables can introduce, rather than eliminate, bias; and how directed acyclic graphs can help us diagnose this problem.This is a rapidly evolving field, and we cover only the most basic elements. The true promise of these techniques is that it may become possible to make robust statements about causation from observational studies-without the expense and artificiality of randomized controlled trials.

journal_name

Anesthesiology

journal_title

Anesthesiology

authors

Gaskell AL,Sleigh JW

doi

10.1097/ALN.0000000000003193

subject

Has Abstract

pub_date

2020-05-01 00:00:00

pages

951-967

issue

5

eissn

0003-3022

issn

1528-1175

pii

00000542-202005000-00012

journal_volume

132

pub_type

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