I couldn't find this anywhere: what was the standard deviation of the mortality rate between non-birthday surgery days?
Elderly patients 23% more likely to die if surgery is on the surgeon’s birthday
181–190 of 222 posts
Re: Elderly patients 23% more likely to die if surgery is on the surgeon’s birthday
#182Earlier quoted context omitted.
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.
/delted/
Re: Elderly patients 23% more likely to die if surgery is on the surgeon’s birthday
#183Earlier 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?
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.
The types of surgeries performed should be controlled for when performing a statistical study.
Re: Elderly patients 23% more likely to die if surgery is on the surgeon’s birthday
#184I recently had a complex facial surgery. Before doing so, I tracked all informations I could about my surgeon.
Everyone had good comments, good healing, very impressive track record, etc.
Everyone but one patient. She complained on how her surgery was rushed, how quick she was out of the operating theater, how she is scarred from it, etc.
At first, I thought she was lying. Why was she such an outlier?
I asked her for more details. It turns out her surgery was in the afternoon of the last friday before the Christmas holidays.
After knowing this, I made sure to schedule in during the middle of the week aways from holidays. My surgery went well.
I am glad to finally have statistics on this gut feeling I had. 23% is a LOT, and the 30% for the holidays is even worst. I had made a mental note to avoid those days, now it's become a rule.
Re: Elderly patients 23% more likely to die if surgery is on the surgeon’s birthday
#185Earlier quoted context omitted.
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.
/delted/
Well it was about this. Empowering them against surgeons in a position of power is still empowerment.
Re: Elderly patients 23% more likely to die if surgery is on the surgeon’s birthday
#186Anecdotally, 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."
There are emergencies, and there are EMERGENCIES. The former can often wait 24 hours; the latter cannot wait at all. Medicare data does not capture that at all - it only captures the categorical, "surgery type."
e.g., someone has a run of the mill cholecystitis that needs to come out. It can go when there's an opening in the surgical schedule, or tomorrow morning. That's an "emergency" - it came in through the ED, wasn't elective.
Then there's the person w/ chole that looks septic and you're afraid they're going to perf or already have. That person is going to the OR now.
Under Medicare coding, both of those are lap choles, CPT 47562. This doesn't control for that at all, except in the broadest of ways.
Also, a 65yo surgical candidate and a 99yo surgical candidate are wildly different. 99yo isn't going under the knife for anything other than immediate threat of death or unendurable pain. In the lap chole example above, I'm going with a trial of abx in the 99yo unless he's absolutely about to perf; 65yo, sure, let's take the gallbladder out - once he's progressed to sx chole, odds are really good it'll have to come out within the next two years. I think most surgeons would rather do it at 65 than 67.
Looking at the 2x2 of 65, 99, emergency, and EMERGENCY, you capture an incredibly large variety of severity and risk.
Re: Elderly patients 23% more likely to die if surgery is on the surgeon’s birthday
#187Re: Elderly patients 23% more likely to die if surgery is on the surgeon’s birthday
#188Earlier quoted context omitted.
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.
[deleted]
Re: Elderly patients 23% more likely to die if surgery is on the surgeon’s birthday
#189I read something similar based on how long the surgeon had been working that day. I always wondered how plausible it was to show up for surgery day and ask the surgeon how many hours of sleep they got the night before and how long they have been working that day.
Re: Elderly patients 23% more likely to die if surgery is on the surgeon’s birthday
#190Earlier quoted context omitted.
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.
Can confirm - had to point to the area that was supposed to be operated while laying in pre-op (or whatever it's called) room, just before being knocked out... Was quite scary ("you should know what you're doing!"), but quite sensible on a second thought.