Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Day of week of procedure and 30 day mortality for elective surgery (2013)

bmj.com

Post reply on HN
Print view View original

21–30 of 88 posts

Re: Day of week of procedure and 30 day mortality for elective surgery (2013)

#21

Post by Frost1x »

mgamache wrote: post #17
glofish wrote: post #2

Almost certainly the selection bias plays a major role - surgeries done early in a week are different than those scheduled later in the week.

I am willing to accept bias, but Why would Monday surgeries be statistically different from Wednesday? Clearly weekend surgeries might be different, but the effect is still present Monday-Thursday. I don't work in healthcare so there might be a selection bias that I am blind to, and I am curious if you have a bias in mind. Also they did track specific procedures and for all but one (with a low n) the procedures track…

If I were a surgeon, after a few days off of leisure to rewind, I certainly wouldn't start with my most risky, potentially problematic cases. Instead, I would try to pick operations that were the most straightforward. These would be almost like "warm ups" for more complex surgeries I would do later in the week.

I'm also not a surgeon...

Re: Day of week of procedure and 30 day mortality for elective surgery (2013)

#22

Post by flyGuyOnTheSly »

I'd believe it.

Rushed to the hospital on a Saturday night when my father in law suffered a massive heart attack... and he was held stable for almost 2 hours before a surgeon capable of working the situation was able to make it in and insert a stent.

It seemed strange to me that a hospital would have a schedule like that... where most doctors work 9 to 5 monday to friday, and most everybody goes home for the weekends.

People can fall ill at any time. Although I suppose the majority of people would only notice that they were ill and come into the hospital during regular business hours.

I noticed this because he was in an induced coma for a few weeks.

At night they lock the place up so tight there is literally only one door in the emergency room that is open to the outside. Something about them being worried about narcotics thefts.

That was a frustrating learning experience our first evening in the hospital, I tell you!

Thankfully he pulled through with flying colors!

Re: Day of week of procedure and 30 day mortality for elective surgery (2013)

#23

Post by mgamache »

Frost1x wrote: post #21
mgamache wrote: post #17

Earlier quoted context omitted.

I am willing to accept bias, but Why would Monday surgeries be statistically different from Wednesday? Clearly weekend surgeries might be different, but the effect is still present Monday-Thursday. I don't work in healthcare so there might be a selection bias that I am blind to, and I am curious if you have a bias in mind. Also they did track specific procedures and for all but one (with a low n) the procedures track…

If I were a surgeon, after a few days off of leisure to rewind, I certainly wouldn't start with my most risky, potentially problematic cases. Instead, I would try to pick operations that were the most straightforward. These would be almost like "warm ups" for more complex surgeries I would do later in the week. I'm also not a surgeon...

Sure, but that implies that surgeons control the operating room schedules. I am not sure that's true (it might be), but it's a contested resource in most hospitals.

Re: Day of week of procedure and 30 day mortality for elective surgery (2013)

#24

Post by [deleted] »

savagedata wrote: post #19

> Choosing Monday for a surgery increases your chance of success 2 times The title seems poorly worded. The researchers studied mortality rate, not success of procedures. Since these were elective surgeries, I assume the success rate was high. If your surgery has a baseline success rate of 90%, what would it mean to increase that 2 times? The conclusion of the study was instead that the odds of death were 44% higher…

[deleted]

Re: Day of week of procedure and 30 day mortality for elective surgery (2013)

#25

Post by [deleted] »

awinter-py wrote: post #13

uhh guessing it halves the % of failures is what they actually mean 30k deaths / 4 million procedures is 0.75% death rate going from 99.25% to 99.6% survival isn't doubling anything also 'success' doesn't appear anywhere in this article, guessing '30 day mortality' is the thing they're measuring

[deleted]

Re: Day of week of procedure and 30 day mortality for elective surgery (2013)

#26

Post by ricardobeat »

flyGuyOnTheSly wrote: post #22

I'd believe it. Rushed to the hospital on a Saturday night when my father in law suffered a massive heart attack... and he was held stable for almost 2 hours before a surgeon capable of working the situation was able to make it in and insert a stent. It seemed strange to me that a hospital would have a schedule like that... where most doctors work 9 to 5 monday to friday, and most everybody goes home for the weekends…

The emergency ward is basically a whole new operation on the side. It is not feasible to keep it staffed with all specialties at all times, due to low volume and sparse distribution of those special cases, compared to scheduled weekday procedures in the hospital. There will be a few doctors doing shifts (sometimes just one), and the rest on call. In smaller areas there might only one or two of each specialty, and they obviously cannot be available 24/7, but will end up jumping out of family activities, sports, school and sleep basically all the time.

Re: Day of week of procedure and 30 day mortality for elective surgery (2013)

#27

Post by bitexploder »

mgamache wrote: post #17
glofish wrote: post #2

Almost certainly the selection bias plays a major role - surgeries done early in a week are different than those scheduled later in the week.

I am willing to accept bias, but Why would Monday surgeries be statistically different from Wednesday? Clearly weekend surgeries might be different, but the effect is still present Monday-Thursday. I don't work in healthcare so there might be a selection bias that I am blind to, and I am curious if you have a bias in mind. Also they did track specific procedures and for all but one (with a low n) the procedures track…

Could just be that they are the most rested then. Or just how the surgeries are ordered. Probably a simple explanation.

Re: Day of week of procedure and 30 day mortality for elective surgery (2013)

#28

Post by CathedralBorrow »

univalent wrote: post #20

Pro tip: if getting a colonoscopy, always always get the first appointment of the day. I work in med devices and ummm those scopes still have poop left over between procedures. Its not harmful, but still...

Why are they not cleaned thoroughly? Just curious.

Re: Day of week of procedure and 30 day mortality for elective surgery (2013)

#30

Post by savagedata »

mgamache wrote: post #17
glofish wrote: post #2

Almost certainly the selection bias plays a major role - surgeries done early in a week are different than those scheduled later in the week.

I am willing to accept bias, but Why would Monday surgeries be statistically different from Wednesday? Clearly weekend surgeries might be different, but the effect is still present Monday-Thursday. I don't work in healthcare so there might be a selection bias that I am blind to, and I am curious if you have a bias in mind. Also they did track specific procedures and for all but one (with a low n) the procedures track…

The problem is with multiple-day recovery periods after the surgery. The later in the week your surgery is scheduled, the more likely you'll overlap with the weekend when care is hypothesized to be lower quality.
Post reply on HN