The letter to the editor raises several concerns about the methodology and assumptions used in a study by Dexter et al. regarding operating room (OR) scheduling algorithms. The author questions the omission of case-duration variance in the simulations, which could significantly impact the results. The data collection method for the probability distribution of open time available for add-on cases is also questioned, suggesting that it might affect the simulation outcomes. The author further inquires about the inclusion of overtime due to "fuzzy constraints" and the impact of different maximum turnover times on the results. Additionally, the letter highlights the need for real-world testing of the algorithms to confirm their applicability to actual OR scheduling problems. The author concludes by emphasizing the importance of addressing these issues to ensure the reliability and validity of the study's findings.The letter to the editor raises several concerns about the methodology and assumptions used in a study by Dexter et al. regarding operating room (OR) scheduling algorithms. The author questions the omission of case-duration variance in the simulations, which could significantly impact the results. The data collection method for the probability distribution of open time available for add-on cases is also questioned, suggesting that it might affect the simulation outcomes. The author further inquires about the inclusion of overtime due to "fuzzy constraints" and the impact of different maximum turnover times on the results. Additionally, the letter highlights the need for real-world testing of the algorithms to confirm their applicability to actual OR scheduling problems. The author concludes by emphasizing the importance of addressing these issues to ensure the reliability and validity of the study's findings.