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

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41–50 of 88 posts

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

#41

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…

> 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.

As another commenter below said, the ER is an entire business model on its own. The goal of an ER is to treat your acute illness or injury and then proceed to push you into a dedicated room to maintain stability. Most (unsourced) emergencies that come into the ER can very likely be stabilized by RN’s and consultation from a MD/DO. honestly, most orders in a setting like these tend to come from the bottom up (RN to MD for approval) if there is a trustworthy relationship between them. Depending on the severity of the patient, of course.

For an example, on 12/30 @ 2345hr, I got extreme abdomen pain and ended up in the ER. On 12/31 at 0200hr, the DO came in and palpated my stomach and concluded I had appendicitis. @ 0300 I was having a CT scan done. @ 0400 the DO was on the phone with the on-call general surgeon to consult with him about surgery for acute appendicitis which led to the eventual rupturing of my appendix. It was then at 1100 when I was in the operating room. Up until this point, every aspect of pain management (morphine every two hrs) and IV fluids were completed by a RN.

For my case, there was no need for a specialist to be on the clock. One was easily in reach but up until that next morning, I had no real need for them besides the one DO who came and put their hands on me as a formality prior to doing a CT scan. I’m mostly just thankful they have specialists to call to begin with.

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

#43
post #36

While I recognize it's an attempt to highlight the "takeaway", the submission title (currently "Choosing Monday for a surgery increases your chance of success 2 times") seriously distorts the actual study contents. It's not analyzing "success" of the surgery, but "30-day mortality for (almost) any cause". (While death caused by the surgery is definitely failure, the absence of death isn't necessarilt "success".) Also…

Submitted title was "Choosing Monday for a surgery increases your chance of success 2 times". That breaks the site guidelines, which say: "Please use the original title, unless it is misleading or linkbait; don't editorialize."

https://news.ycombinator.com/newsguidelines.html

Cherry-picking the detail you think is most important from an article is a form of editorializing. If you want to say what you think is important about an article, please post it as a comment to the thread. Then your view will be on a level playing field with everyone else's.

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

#45

Maybe it's because surgeons on average tend to put off more difficult surgeries to a later day in the week. They don't want to come into the operating theater after a weekend of hard drinking and have to do a complex brain operation on Monday morning. So they will organize their schedule so that they only do routine low-risk operations on Mondays.

I don't know. "No change on Friday" also sounds like a reasonable rule when it comes to essential parts of the human body.

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

#46
post #33

I'd rephrase the submission title to 'choosing the first working day of the week for a surgery doubles your chance of success" In the US it is Monday as in the title, but in other countries, Israel for example, it would be Sunday.

Israelis reading HN will "get it" when reading the current title.

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

#47

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

It’s 99ish% odds of no event. Going from 0.4% to 0.75% is pretty close to doubling the odds of seeing an event though.

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

#48
post #33

I'd rephrase the submission title to 'choosing the first working day of the week for a surgery doubles your chance of success" In the US it is Monday as in the title, but in other countries, Israel for example, it would be Sunday.

The study was done in England. Unfortunately the results can't be generalized to the rest of the world.

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

#49

Earlier quoted context omitted.

Why are they not cleaned thoroughly? Just curious.

And if they are and yet still contain fecal matter, how does going in the next day help? Your appointment is still after someone else's. Do they use a new scope?

Theoretically, some bacteria could have died overnight, which would be good. In general, simple instruments constructed of stainless steel or other solid non-porous materials are easy to wash off and autoclave. Complicated constructions in which multiple parts fit precisely inside other parts constructed of different materials are not easy to wash and autoclave. Scope manufacturers would be encouraged to design more sensibly if physicians could be held accountable for cross-contamination. This would require a more aggressive regulatory regime.

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

#50

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…

I think you missed the word "elective", I guess the whole point was to remove emergency surgery from the study.
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