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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

#121

Post by throwawaylolx »

kkoncevicius wrote: post #19
voxl wrote: post #4

Earlier quoted context omitted.

I feel like we need an opposite saying for sentiments like this to the age old "correlation does not equal causation", something like "correlation does not mean automatically dismiss"

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…

Why are you and others assuming this was the case and it wasn't the original hypothesis they had in mind?

They explain the reasoning for selecting this hypothesis to test:

>Operations performed on birthdays of surgeons might provide a unique opportunity to assess the relationship between personal distractions and patient outcomes, under the hypothesis that surgeons may be more likely to become distracted or feel rushed to finish procedures on their birthdays, and therefore patient outcomes might worsen on those days.

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

#122

Post by bluesign »

“ 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”

Actual data: 2064/980876 operation on bday 6.9% die, rate = 142 death

Expected: (if we use non bday death rate)

1/365=0.0027 2687 operation With better 5.6% death rate = 150 death

So deaths are only 6% more, so basically they are doing less and more emergency operations on birthday, so death rate is increasing it seems.

It means they are making 23% less operations on birthday then any normal day.

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

#123

Post by throwawaylolx »

moosinho wrote: post #99
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

Good point. That's probably also the case for surgeries on national holidays.

It is:

>The effect size of surgeons’ birthday observed in our analysis (1.3 percentage point increase or a 23% increase in mortality), though substantial, is comparable to the impact of other events, including holidays (eg, Christmas and New Year) and weekends, which have been argued to affect the quality of patient care.

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

#124

Post by wruza »

fart32 wrote: post #95
wruza wrote: post #47

More than a decade ago we had to digitize some org’s patient cards into a database. After running few “test” queries against that dataset out of curiosity we found out that you’re less likely to be alcoholic-y if you live on 4-5 floor. The explanation I thought was that they hang out outside, but those who live higher have harder time to go home and prefer to not go. Building with 6+ stories usually have an elevator…

This might be different elsewhere, but here, the apartments on lower floors are typically rented and they're cheaper than those on higher floors. It's the case at the building I currently live in, although it's because on the lower floors, there are more apartments (smaller ones) than on the higher ones. Roof apartments are all sold out, not rented. So, I could imagine, that the higher floors are occupied by more wea…

Perhaps. The answer is it’s unknown. It was the first time I met correlation so clearly irl, and my idle guess was naive and obviously stupid.

There was no info on building types or sqft/m2, but lower and higher floors are historically cheaper here (1st is little loud/non-private and last is little cold and flood-prone).

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

#125

Post by throwawaylolx »

The results are a lot less interesting when you read that the risk increase they found is comparable to that present during regular weekends:

>The effect size of surgeons’ birthday observed in our analysis (1.3 percentage point increase or a 23% increase in mortality), though substantial, is comparable to the impact of other events, including holidays (eg, Christmas and New Year) and weekends, which have been argued to affect the quality of patient care.

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

#126

Post by EvanAnderson »

michaelt wrote: post #120
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.

I know people who have been instructed to do this by medical staff prior to surgery. I have personally helped someone mark a mole they couldn't reach on their back.

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

#127

Post by poooogles »

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?".

If you want to read more on the background of this The Checklist Manifesto is a great book and has lots of applications when it comes to IT operations. Stupid checklists in markdown that you can check off as you go through have certainly improved our performance in ad hoc tasks that we don't automate.

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

#128

Post by bookofjoe »

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?".

Back when I was still practicing as an anesthesiologist (1977-2015) I had a pack of 3x5 cards I carried in my scrubs pocket on each of which was an exhaustively detailed list I'd made of EVERYTHING I needed at hand to perform specialized procedures such as inserting an arterial line (putting a #20g plastic catheter through the skin on the inside of the wrist into the radial artery for direct beat-to-beat monitoring of arterial blood pressure, a measurement employed for seriously ill or unstable patients). I would assemble a tray with the following items in the OR before going to ICUs or the ER because invariably one or more of the items I would need would not be present and would take time to procure.

For example:

ARTERIAL LINE

• several sterile alcohol skin wipes • 3cc syringe with 25g needle [for skin infiltration of local anesthetic at puncture site] • bottle of 2% lidocaine with epinephrine 1/1000 • 2x2 cotton gauze pads to use for pressure on failed puncture sites • 3 #20 gauge plastic catheters (22 gauge for small children) • 2 surgical towels to drape over hand and lower arm to absorb blood that accompanied successful arterial puncture • size 7.5 sterile surgical gloves for me to wear while performing procedure • specialized 1" waterproof plastic skin tape to secure and protect catheter in situ

I was constantly amazed by how my colleagues would have to stop and wait for something not present in the unit they were called to. Conversely, when I was called because of an inability to insert an A-line, as they were referred to, and wasn't in a place where I could assemble my desired materials, I'd proceed with the materials at hand, all the while thinking "this could have been done a lot better...."

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

#129

Post by watwut »

Galanwe wrote: post #104
faeyanpiraat wrote: post #102

Earlier quoted context omitted.

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.

The long term plans and studied for surgeries can be moved one day forward or backward basically by definition.

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

#130

Post by watwut »

englishrookie wrote: post #38
spiderfarmer wrote: post #24

Earlier quoted context omitted.

I never took the day off on my birthday, but a lot of people do. So it might also make sense to ask why these surgeons are operating on their birthdays. Did they take the day off and went back to perform surgery on a critical patient? Are they overworked? Etc.

Is that a thing in the US, taking a day off on your birthday? To the best of my knowledge, nobody does that in Europe - certainly not in the Netherlands.

Never seen anyone to take a day off on birthday. Living in Europe too.
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