Clarification of issues brought up by 'Is continuing nursing interventions reduce the incidence of intraoperative pressure ulcers for breast cancer patients?'.

We are glad to read your letter (1) and would like to clarify some key issues you mentioned about our study (2).

First, PROSPERO platform (https://www.crd.york.ac.uk/PROSPERO/) registration is not a strict requirement based on the PRISMA (the Preferred Reporting Items for Systematic Reviews and Meta-analyses) guideline. We didn’t register our review on PROSPERO or Cochrane due to time limit, which is kind of an omission for our work flow. We would change the work flow and register the meta before our key work begin. We didn’t introduce NOS (Newcastle-Ottawa Scale) to quality assessment because the NOS scale is for observational studies, not for randomized controlled studies. Instead, we use the Cochrane Risk of Bias Scale to assess the bias of the studies, and we detailed the bias of the 6 aspect in the Figs. 2,3, which is more clear to display the quality than scores.

Second, for the inclusion criteria, we did mentioned patients should live in the city (Chengdu, China), and that is a text mistake. We are glad you pointed it out and we will contact the editor for a revise. We included the studies all in Chinese, because we didn’t find any studies in English for this topic.

Third, heterogeneity exists between the studies when pooling the data of braden risk score and quality of life. However, only 3 studies included for braden risk score and 6 for quality of life, that will make our heterogeneity investigation process unreliable, so we chose not to do it.

The total number of studies included was 9, but only 6 of them report the quality of life outcome, which is not a mistake.

For the publication bias, we think you are right and we should have used Begg’s or Egger’ test for more accuracy.

The article’s supplementary files as