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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

#131

Post by watwut »

throwawaylolx wrote: post #121
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…

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 rush…

Because popular hobby on HN is trying to find mistakes in studies by guessing from title without reading article.

Incidentally, interestingly, that is how bias in real world often works - people making different assumptions for different groups in absence of evidence.

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

#132

Post by redis_mlc »

sebmellen wrote: post #3

> The researchers emphasized that this study focused on common procedures, and on older Medicare patients. This means that the findings may not apply to other types of patients, or to other surgical procedures. Is there any reason Medicare would play a role in the surgeon's performance?

> Is there any reason Medicare would play a role in the surgeon's performance?

Lots of reasons:

"Generally, Medicare is available for people age 65 or older, younger people with disabilities and people with End Stage Renal Disease (permanent kidney failure requiring dialysis or transplant)."

And often poorer than private insurance, so less preventive and post-operative care and rehabilitation.

eg. I watched a documentary on urban diabetes patients and foot amputations. Amputation is literally an epidemic in poor Americans because they can't afford homecare, so have to keep walking on a gangrenous foot until it turns black.

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

#133

Post by ChrisLomont »

esquire_900 wrote: post #32
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…

You make a good point, though I'd like to add that one would expect 1/365 = .274% of procedures to be on a random day (like a birthday). .21% is not so far off that it can't be random chance.

> .21% is not so far off that it can't be random chance

How far off exactly would it need to be before it can be random chance?

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

#134

Post by randomsearch »

Aissen wrote: post #48
phreeza wrote: post #36

Earlier quoted context omitted.

They included a surgeon control variable in their model. https://www.bmj.com/content/bmj/371/bmj.m4381.full.pdf

Yes, they say they did all this (and much more) in secondary analyses. I'm curious how does one find the eTables supplementary information ? Edit: nevermind, found it: https://www.bmj.com/content/bmj/suppl/2020/12/09/bmj.m4381.D... Edit 2: it looks like solid, peer-reviewed research

Ah, couldn't access the page so had assumed parent was correct reporting that they hadn't done this control. Sorry for getting that wrong - won't trust similar posts in the future.

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

#135

Post by throwaway2245 »

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?".

There's increasing suggestion that the claimed benefits of using checklists have not been reproducible in RCTs:

e.g. https://www.bmj.com/content/366/bmj.l4700.full

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

#136

Post by tomxor »

ZeroGravitas wrote: post #119
tomxor wrote: post #94

Earlier quoted context omitted.

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.

Ouch. This reminds me of the problems nurses faced in the 80s as described in "Pragmatic Thinking and Learning". From that book it made it sounds as thought the issues were mostly historic, I guess there have been a number of different battles fought.

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

#137

Post by daniellarusso »

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.

A surgeon seems more fungible than a developer, to me.

All sorts of standards, compliance, and licensing requirements.

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

#138

Post by soco »

Ensorceled wrote: post #117
soco wrote: post #112

Earlier quoted context omitted.

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

Where is the "one surgeon" sample size?

It's about the success of surgery on that surgeon's birthday, and calculating the implications of switching the surgery types etc etc, while in a real world situation you'd just use the other surgeon - which hopefully has another birthday. I agree there's gonna be some smaller effect even then, but less and less the more surgeons you have and the more randomly distributed their birthdays are.

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

#139

Post by kennywinker »

oblio wrote: post #91
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?".

People are vain. People's vanity is so strong that they are willing to kill and maim others and even do insane things such as declaring wars. Regarding your checklist, you should read about Semmelweiss: https://en.wikipedia.org/wiki/Ignaz_Semmelweis It's crazy to think that entire generations of doctors retired and died arguing against washing your hands!

Might have surprised me before 2020, but the amount of people throwing hissy fits over masks this year has prepared me for the ridiculous stubbornness of humans asked to change.

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

#140

Post by ceejayoz »

daniellarusso wrote: post #137
Galanwe wrote: post #104

Earlier quoted context omitted.

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.

A surgeon seems more fungible than a developer, to me. All sorts of standards, compliance, and licensing requirements.

Those requirements are fairly general.

They don't test for "I've been doing this particularly tricky type of bone biopsy right next to the spinal cord for decades" scenarios.

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