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Elderly patients 23% more likely to die if surgery is on the surgeon’s birthday

psychnewsdaily.com

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Re: Elderly patients 23% more likely to die if surgery is on the surgeon’s birthday

#101

Post by praptak »

mhh__ wrote: post #52

https://www.england.nhs.uk/2019/01/surgical-safety-checklist... Getting surgeons to adopt the kind of "It's obvious but point and speak or you're fired"-style checklists a la operating an aircraft has reduced complications (from the minor to deaths) by several percent in the NHS. It's perhaps worrying given how low-hanging some of these fruit are - i.e. "Do we have the right patient?".

Procedures in hospitals are interesting. I recently visited a hospital and there was a red sign above the table where nurses dose medicines for patients: "No room numbers on trays, no bed numbers on trays". Seems like a low hanging fruit but a very non-obvious one (well at least non-obvious to me).

Re: Elderly patients 23% more likely to die if surgery is on the surgeon’s birthday

#102

Post by faeyanpiraat »

colonwqbang wrote: post #84
Ensorceled wrote: post #79

Anecdotally, my father-in-law was chief of staff for a small city hospital and they had a rule about not scheduling afternoon surgeries on important days like anniversaries, birthdays, etc. Basically, if the surgery started going long, you didn't want the surgeon worrying about missing their spouses birthday, birthday with their kids or an anniversary. It actually wasn't that many surgeries delayed, as the surgeon ju…

This is a beautiful conjecture! The problem is amusingly circular. Even if you reject the conjure in parent comment, you will be tempted to reduce the number of birthday surgeries due to the increased mortality. This will mean that birthday surgeries are only done in even more desperate circumstances which of course will increase the risk. So mitigation of this problem will lead to the percentage increasing even more…

I do not completely understand your points.

Shouldn't hospitals have multiple surgeons?

If one of them is on vacation, the other one does the work, and vice versa?

Re: Elderly patients 23% more likely to die if surgery is on the surgeon’s birthday

#103

Post by Someone »

For those wondering about that “elderly”: the researchers only looked at “100% fee-for-service Medicare beneficiaries aged 65 to 99 years who underwent one of 17 common emergency surgical procedures in 2011-14” (https://www.bmj.com/content/371/bmj.m4381), so they didn’t check whether this applies to non-elderly patients.

It also is worth noting that this is published in the BMJ Christmas Issue (https://www.bmj.com/about-bmj/resources-authors/article-type...), so it should be taken with a grain of salt.

Re: Elderly patients 23% more likely to die if surgery is on the surgeon’s birthday

#104

Post by Galanwe »

faeyanpiraat wrote: post #102
colonwqbang wrote: post #84

Earlier quoted context omitted.

This is a beautiful conjecture! The problem is amusingly circular. Even if you reject the conjure in parent comment, you will be tempted to reduce the number of birthday surgeries due to the increased mortality. This will mean that birthday surgeries are only done in even more desperate circumstances which of course will increase the risk. So mitigation of this problem will lead to the percentage increasing even more…

I do not completely understand your points. Shouldn't hospitals have multiple surgeons? If one of them is on vacation, the other one does the work, and vice versa?

I don't think surgeons are fongible assets. There is a lot of planning and study taking place before a complex operation. Not to mention most surgeons have specialties.

Re: Elderly patients 23% more likely to die if surgery is on the surgeon’s birthday

#105

Post by dj_mc_merlin »

quickthrower2 wrote: post #73

I’m going to guess (article won’t load for me) it is because the title should be “proportion of elderly deaths is 23% higher for surgery done on surgeons birthday” which might be a different thing if working on your birthday confounds with a certain type of surgery E.g. emergency surgery and being on call vs. elective surgery

That is not correct, the article talks about methodology:

> The patients were all Medicare beneficiaries aged 65 to 99. They had all undergone one of 17 common emergency surgical procedures between 2011 and 2014. Examples of those 17 procedures included cardiovascular surgeries, hip and femur fracture, appendectomy, and small bowel resection. The study focused on emergency surgery, so as to minimize the potential selection bias. For example, surgeons might otherwise choose patients based on their illness severity, or patients might choose their surgeon.

Re: Elderly patients 23% more likely to die if surgery is on the surgeon’s birthday

#106

Post by jgtrosh »

faeyanpiraat wrote: post #102
colonwqbang wrote: post #84

Earlier quoted context omitted.

This is a beautiful conjecture! The problem is amusingly circular. Even if you reject the conjure in parent comment, you will be tempted to reduce the number of birthday surgeries due to the increased mortality. This will mean that birthday surgeries are only done in even more desperate circumstances which of course will increase the risk. So mitigation of this problem will lead to the percentage increasing even more…

I do not completely understand your points. Shouldn't hospitals have multiple surgeons? If one of them is on vacation, the other one does the work, and vice versa?

But the more you avoid birthday surgeries altogether, the more those that end up still happening are extreme cases with high mortality rates. So if your target is to avoid this scary statistical anomaly, you might instead want to promote more benign surgeries on birthdays.

Re: Elderly patients 23% more likely to die if surgery is on the surgeon’s birthday

#107

Post by Operyl »

faeyanpiraat wrote: post #102
colonwqbang wrote: post #84

Earlier quoted context omitted.

This is a beautiful conjecture! The problem is amusingly circular. Even if you reject the conjure in parent comment, you will be tempted to reduce the number of birthday surgeries due to the increased mortality. This will mean that birthday surgeries are only done in even more desperate circumstances which of course will increase the risk. So mitigation of this problem will lead to the percentage increasing even more…

I do not completely understand your points. Shouldn't hospitals have multiple surgeons? If one of them is on vacation, the other one does the work, and vice versa?

There’s research, consultations, who is covered under what insurance, etc.

Re: Elderly patients 23% more likely to die if surgery is on the surgeon’s birthday

#108

Post by helsinkiandrew »

boomboomsubban wrote: post #55
svrtknst wrote: post #50

Earlier quoted context omitted.

Are they? Sounds odd that the norm would be for people to take birthdays off.

I may be making this up, but aren't there some rather strict rules about surgeons and alcohol? It may make them more likely to just take the day off.

I'd guess that few surgeons start boozing at breakfast on their birthday or have a lunchtime drinking session to celebrate. But are more likely to be rushing off to have a party than actually be impaired.

Re: Elderly patients 23% more likely to die if surgery is on the surgeon’s birthday

#109

Post by roenxi »

mhh__ wrote: post #52

https://www.england.nhs.uk/2019/01/surgical-safety-checklist... Getting surgeons to adopt the kind of "It's obvious but point and speak or you're fired"-style checklists a la operating an aircraft has reduced complications (from the minor to deaths) by several percent in the NHS. It's perhaps worrying given how low-hanging some of these fruit are - i.e. "Do we have the right patient?".

> It's perhaps worrying given how low-hanging some of these fruit are...

You don't realise how "bad" normal operational discipline is until you've seen it done right. The risk isn't so much that people skip a step, but that phantom steps start creeping in because people aren't quite sure of the standard, that saps a surprising amount of resources away which could be used for checking mistakes. And then people get disorganised and potential holes appear.

A big part of excellence isn't doing the right steps, it is trimming out the steps that don't need to be there, to focus attention on the stuff that works.

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