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

bmj.com

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

#61

Post by tomrod »

bosie wrote: post #18
jeffdavis wrote: post #8

A mortality rate of 0.7% for elective procedures sounds high. What counts as elective but carries such risk? Is it similar in other countries?

They aren't measuring the mortality rate of the procedure. they are measuring this: "Death in or out of hospital within 30 days of the procedure." If I am already on my death bed (for lack of better word), the procedure's mortality rate is probably not swaying it much. Also, couldn't find if they would include something like a lethal car accident 28 days after the procedure or not. > An elective procedure was defined…

If one uses an "episode of care" framework, mortality within 30 days of treatment is a standard metric.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Paymen...

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

#62

Post by univalent »

Defenestresque wrote: post #37
technofiend wrote: post #31

Earlier quoted context omitted.

I'm no expert but aren't you exposing one patient to the previous patient's poop? There could be anything from a lovely c-diff payload to something the next guy is allegeric to like nuts. As a layperson it hardly seems harmless.

I have a feeling OP means they are sterilized or autoclaved but some (now non-dangerous) particles remain as there is no medical point in thoroughly cleaning them after sterilization. Which would make sense.

Exactly.

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

#63

Post by JoshTriplett »

tmpz22 wrote: post #58
samatman wrote: post #11

Earlier quoted context omitted.

> If hunger had an effect on our mental resources of this magnitude, our society would fall into minor chaos every day at 11:45 a.m. ...this has potential! Scrape GitHub, find closed issues marked 'bug', do a blame on the offending line or lines, find the timestamp and plot.

It would be a pita to control for time zones, or even culturally different lunch times and eating habits

Git commits do embed a timezone in the commit timestamp. And while lunchtime will vary by person, there may still be a visible effect around common lunchtimes over a large number of people.

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

#64

Post by samatman »

tmpz22 wrote: post #58
samatman wrote: post #11

Earlier quoted context omitted.

> If hunger had an effect on our mental resources of this magnitude, our society would fall into minor chaos every day at 11:45 a.m. ...this has potential! Scrape GitHub, find closed issues marked 'bug', do a blame on the offending line or lines, find the timestamp and plot.

It would be a pita to control for time zones, or even culturally different lunch times and eating habits

Time is an illusion; lunchtime, doubly so.

The hypothesis I would personally register is that bugs increase after 5:30 PM, and that this effect drops off in late evening hours.

Basically, that compelling one's employees to stay late is an anti-pattern, where one loses more than one gains.

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

#65

Post by lrem »

phkahler wrote: post #34
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

Yeah that's the main reason i had to read it. Even if you got to 100 percent on Monday that would imply only 50 percent success on other days. Nobody would have an elective procedure with that low success rate.

Success rates are often not that high. Also depends on the exact definition of success. Say for carpal tunnel, from that I've read, the "there was any improvement" success rate is about 90%, but the "fully healed" success rate is as low as 15%.

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

#66

Post by dehrmann »

I can't find a source, but 70's-era wisdom I got from my grandfather was when buying an American car, buy one assembled on a Tuesday. People are hungover on Monday, Tuesday is their best work day, it's downhill on Wednesday and Thursday, and they're checked out on Friday.

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

#67

Post by tcoff91 »

dehrmann wrote: post #66

I can't find a source, but 70's-era wisdom I got from my grandfather was when buying an American car, buy one assembled on a Tuesday. People are hungover on Monday, Tuesday is their best work day, it's downhill on Wednesday and Thursday, and they're checked out on Friday.

How can you possibly figure out when a car was assembled?

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

#68

Post by glofish »

Frost1x wrote: post #53
mgamache wrote: post #23

Earlier quoted context omitted.

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.

Outside of emergency surgeries, I imagine anything scheduled that isn't of immediate risk surgeons have a reasonable amount of control over, given of course the magnitude and distribution of surgeries that need performed. I can't imagine they don't look at their schedules regularly and talk to whomever does scheduling to make their lives more bearable. When they're on ER rotation, surgeons of course really have no po…

ER cases might also not serve as a proper control - the types of injuries and accidents over the weekend will likely be different from those during the week days

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

#70

Post by gist »

dehrmann wrote: post #66

I can't find a source, but 70's-era wisdom I got from my grandfather was when buying an American car, buy one assembled on a Tuesday. People are hungover on Monday, Tuesday is their best work day, it's downhill on Wednesday and Thursday, and they're checked out on Friday.

I remember that from the 70's as well.
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