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

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

#111

Post by Galanwe »

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…

> If this is fairly standard practice, then an afternoon birthday surgery would be an emergency situation and, hence, more deadly

This is spot on. The causality can be both ways.

Note that it would be interesting to dig into what is really computed here, because the whole wording seem intentionally sensationalistic.

1) "23% more likely to die" seems _huge_, but it applies to an already very small chance. The mortality rate just goes from 5.6% to 7%. Using this logic, moving from 0.1% mortality rate to 0.3% would mean "you are 3 times more likely to die".

2) Comparing mortality rates only make sense if the distribution of operation complexity are identical for these days. As the parent post suggest, it seems very likely that low complexity operations are postponed after a surgeons birthday.

3) Where are the confidence intervals? I refuse to even consider looking at a statistics if error boundaries and significance metrics are not provided.

That may very well all be provided in the underlying paper, but the article itself does not really discuss these points.

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

#112

Post by soco »

Galanwe wrote: post #111
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…

> If this is fairly standard practice, then an afternoon birthday surgery would be an emergency situation and, hence, more deadly This is spot on. The causality can be both ways. Note that it would be interesting to dig into what is really computed here, because the whole wording seem intentionally sensationalistic. 1) "23% more likely to die" seems _huge_, but it applies to an already very small chance. The mortalit…

Aren't we doing here statistics on a one-surgeon sample size?

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

#113

Post by kkoncevicius »

Dylan16807 wrote: post #85
kkoncevicius wrote: post #19

Earlier quoted context omitted.

The comment you replied to has nothing to do with "correlation does not equal causation". The point was that fishing for results, by trying everything, is guaranteed to find something. So if, in a study like this, they looked at differences in morality rate between: 1) men and women, 2) younger and older people, 3) younger and older surgeons, 4) surgeries in summer vs winter 4) surgeries in morning vs evening 5) etc…

> Then it would be almost guaranteed that such a finding is spurious. But that's the fallacy. You can't just preemptively assume that there are no real correlations. You definitely want to use a smaller p threshold when you look for more things, but it's quite possible to hit real correlations with a pile of plausible hypotheses. As an example: Let's say just 1/150 of your hypotheses hit a real correlation, and you'r…

> [...] but it's quite possible to hit real correlations with a pile of plausible hypotheses.

Yes of course. But the trouble is that, if you do this p-hacking expedition, you are guaranteed to find those correlations in pure noise. So if you use a procedure that will find something in noise - you cannot also use it to claim to have found something in your data.

In the words of statistics philosopher Deborah Mayo - "A conjecture passes a test only if a refutation would probably have occurred if it's false". In this case no refutation would have occurred if the correlation is false. Hence - the result is equivalent as if no test has actually been performed.

Or, a more simplistic example, imagine if someone observes an asteroid and says "it might be aliens". Some astro-physicists then describe that all the observed properties of that object behave just as we expect them to behave in the case of an asteroid. But the person might then reply with: "yeah, but it still might have been aliens".

I feel that the same is true for "yeah, but the correlation might still be true".

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

#114

Post by phreeza »

helsinkiandrew wrote: post #16

> They also found that some surgeons did not work on their birthdays Is this partially that better/more experienced/senior/more affluent doctors are taking their birthday off, hence people getting more junior doctors? It would be interesting to see how many more people die on a particular surgeons birthday compared with the rest of their year, rather than the birthday of the surgeon a patient gets.

The study controls for surgeon factors, so this is taken care of.

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

#116

Post by [deleted] »

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…

[deleted]

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

#117

Post by Ensorceled »

soco wrote: post #112
Galanwe wrote: post #111

Earlier quoted context omitted.

> If this is fairly standard practice, then an afternoon birthday surgery would be an emergency situation and, hence, more deadly This is spot on. The causality can be both ways. Note that it would be interesting to dig into what is really computed here, because the whole wording seem intentionally sensationalistic. 1) "23% more likely to die" seems _huge_, but it applies to an already very small chance. The mortalit…

Aren't we doing here statistics on a one-surgeon sample size?

Where is the "one surgeon" sample size?

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

#118

Post by throwawaylolx »

wjnc wrote: post #34
kkoncevicius wrote: post #13

> The study, which appears today in the British Medical Journal (BMJ), looked at 980,876 procedures performed in US hospitals by 47,489 surgeons. Of those procedures, 2,064 (0.2%) took place on a surgeon’s birthday. So, only a fraction of the surgeons performed operation on their birthdays. Would be interesting to compare the outcomes using the same surgeon group: surgeries on birthday vs same-surgeon surgeries on ot…

They included fixed effects for hospitals and surgeons: "To test whether our findings were affected by including both hospital and surgeon fixed effects in the same regression models." [1] Perhaps the link could be changed to the paper itself? [1] https://www.bmj.com/content/371/bmj.m4381

>Perhaps the link could be changed to the paper itself?

Especially since OP's link won't load.

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

#119

Post by ZeroGravitas »

tomxor wrote: post #94
danpalmer wrote: post #88

Earlier quoted context omitted.

> It's perhaps worrying given how low-hanging some of these fruit are - i.e. "Do we have the right patient?" It turns out that while it's a good idea to check things this "low-hanging", the value is far larger than catching wrong patients, so don't worry too much! Much of the value comes from essentially disrupting routine with an opportunity to stop, and from creating a culture of speaking up. I think the NHS was th…

That's excellent! it never occurred to me it could have such a positive effect in a team situation. Empowering the supporting members is very insightful, they may be supporting but they are just as critical, they need to feel appreciation for the value they provide to stay sharp and motivated - I hope this can be applied to other contexts, thanks for sharing this.

If I remember the anecdotes correctly, the focus on nurses wasnt as cheery as this. Basically, the nurses often knew when the surgeon was in the process of making a mistake, up to cutting the wrong leg off a patient, but kept quiet because surgeons had the power to ruin their careers if they "embarressed" them. So the innovation was really about forcing surgeons to not terrify their nurses into silence.

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

#120

Post by michaelt »

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?".

Reminds me of a scene in House, where the cynical veteran doctor about to receive surgery on his right leg uses a sharpie to write "NOT THIS LEG" on his left leg.
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