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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

#171

Post by marcinzm »

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.

Surgeons are generally specialists in one particular area and possibly even specialists within that area (ie: only do knee replacements, etc.). Surgeons get better with experience, it's a skill, and different surgeries are different enough that experience doesn't transfer too much. There's also changes over time in best practices so skills degrade not just due to lack of recent experience. If I remember the best predictor of the outcome of your surgery is how many similar surgeries the doctor does per year.

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

#172

Post by WarOnPrivacy »

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.

As pointed out by jlebar, this is controlled for by comparing similar emergency surgeries.

"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."

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

#173

Post by mikestew »

rightbyte wrote: post #37
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.

I mean surgeries on Christmas probably are way more fatal too since they are the ones that can't wait. You would excepct that it is the day after your birthday the surgeon is worse (risk for hangover or less sleep).

It’s coming up on a year since I got wheeled into the operating room as my Christmas present for 2019. I’m obviously still here to tell the tale, but the thought did cross my mind: “how much of a hurry are you to get home, Dr. Takiyama?” But according to TFA, a Christmas Day surgery was about equal in risk to one on the surgeon’s birthday. Which means my worries weren’t entirely unfounded.

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

#174

Post by bookofjoe »

bookofjoe wrote: post #128
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 o…

Note added after HN editing hour closed: The reason I created these Procedure Cards is that when I was really tired — for example at 1 a.m. after I'd been on call and working 18 hours since 7 a.m. the previous day, with six more hours to go till I was relieved at 7 a.m. — I invariably forgot something I needed and had to wait or make do because of this fatigue-induced lapse. With my list, I was able to do what I knew how to do without having to try and remember a zillion specific things.

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

#175

Post by UncleMeat »

jlebar wrote: post #151
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. TFA says they're only counting emergency surgeries, to avoid exactly this bias.

This is the most frustrating pattern in online discussion of science. A post title presents a conclusion, then the top comment proposes some alternative cause of the conclusion or some hypothesized methodological weakness in the research, then readers assume that the research is bad. Often, the exact specific criticism appears directly in the paper because the researchers thought of that too.

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

#176

Post by UncleMeat »

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 isn't a good point. This was explicitly controlled for in the study. People are just making wild guesses about methodological limitations that don't exist.

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

#177

Post by nvrGiveUp »

seebetter wrote: post #115

I’ve worked with a lot of surgeons and have heard/seen a lot of unbelievable things. Human beings are human. And often poorly educated in principles and ethics.

Medical is beyond Science unfortunately. The club exists to protect their extraordinarily high wages and protect them from punishments.

There's a reason physicians don't consider themselves scientists. If they make an error they can claim they knew from Tradition/Art/Authority.

It's politically impossible to outspend the US Physician Cartel (AMA), so I doubt we will have a Science based alternative or science based reform.

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

#178

Post by rzzzt »

tomxor wrote: post #80
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?".

I'm probably going to sound silly now but I do this when doing any technical work I deem important or critical enough, point and say outloud what it's for or what state it should be in or in the imperative what to do to it... it does work, it somehow catches silly mistakes compared to keeping everything in your mind, and also gives you confidence because it works like a checklist. Known as pointing and calling in tra…

I do this when I am the last to leave a building. "This window is closed... these lamps are off". I read about the transport-related part of it in this article: https://www.atlasobscura.com/articles/pointing-and-calling-j...

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

#179

Post by misiti3780 »

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…

Not exactly the same by similar:

My father is a surgeon at a small hospital and my mother just got her hip replaced a few weeks ago (at a different, larger city hospital) and the first thing he insisted on was she was scheduled as the first patient of the day.

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