191–200 of 222 posts
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.
The long term plans and studied for surgeries can be moved one day forward or backward basically by definition.
So they went to fish for correlations and found this? EDA at its best...
On the meanwhile, a news reporter gets your (probably spurious) correlations and announce them for the entire world as "the TRUTH! science says so, and you don't doubt science, do you?"
That's basically how science gets done on any complex field where we can't test things directly.
Earlier quoted context omitted.
> 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.
In this case, based on another comment above about "emergency procedure" having multitude of meanings, you're most likely wrong in that the paper has a rebuttal to the top post. The hypothesis then, is that the actual urgency of surgeries is not controlled precisely enough to state that they cannot affect the measurement.
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…
But that is indeed precisely what it means. The 737 MAX might have increased the accident rate from 1 in a million to 3 in a million, and that would have been a tripling. That is not sensationalistic.
> 3) Where are the confidence intervals?
In the paper: "(7.2% v 5.6%; adjusted difference 1.6%, 95% confidence interval 0.4% to 2.8%; P=0.01)"
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…
> The major threat to the internal validity of our findings is that surgeons may selectively operate on sicker and more complex patients on their birthday, perhaps because those patients cannot have their procedures delayed. However, this is unlikely to explain our findings because we found that patients who underwent surgery on the surgeon’s birthday were similar in all observable characteristics to patients who underwent surgery on other days. Furthermore, severity of illness as measured by predicted mortality, and the number of procedures performed per surgeon, also did not differ based on whether a surgery occurred on a surgeon’s birthday compared with other days.
It seems to me that the analysis is quite carefully done:
> Findings were qualitatively unaffected by: using in-hospital mortality instead of 30 day mortality; additionally adjusting for the timing of the surgery; including both hospital and surgeon fixed effects in the same regression models; excluding potentially outlier surgeons with the highest mortality; using logistic regression models instead of linear probability models: using random effects models instead of fixed effects models; restricting our analysis to surgeons who performed procedures on their birthdays; additionally adjusting for the day of the year; or excluding surgeons who were born on the outlier birthdays (supplementary eTables 5-13). [...] The study findings were qualitatively unaffected when the analysis was restricted to procedures with the highest average mortality or to patients with the highest severity of illness (supplementary eTables 16 and 17).
Earlier quoted context omitted.
> 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.
From the paper:
"The major threat to the internal validity of our findings is that surgeons may selectively operate on sicker and more complex patients on their birthday, perhaps because those patients cannot have their procedures delayed. However, this is unlikely to explain our findings because we found that patients who underwent surgery on the surgeon’s birthday were similar in all observable characteristics to patients who underwent surgery on other days. Furthermore, severity of illness as measured by predicted mortality, and the number of procedures performed per surgeon, also did not differ based on whether a surgery occurred on a surgeon’s birthday compared with other days."
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?".
> 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…
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…
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…
> 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". But that is indeed precisely what it means. The 737 MAX might have increased the accident rate from 1 in a million to 3 in a million, and that would have been a tripling. That…
Earlier quoted context omitted.
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.
No reason to be frustrated. Things are almost never right or wrong, particularly in complex science. In this case, based on another comment above about "emergency procedure" having multitude of meanings, you're most likely wrong in that the paper has a rebuttal to the top post. The hypothesis then, is that the actual urgency of surgeries is not controlled precisely enough to state that they cannot affect the measurem…
> The major threat to the internal validity of our findings is that surgeons may selectively operate on sicker and more complex patients on their birthday, perhaps because those patients cannot have their procedures delayed. However, this is unlikely to explain our findings because we found that patients who underwent surgery on the surgeon’s birthday were similar in all observable characteristics to patients who underwent surgery on other days. Furthermore, severity of illness as measured by predicted mortality, and the number of procedures performed per surgeon, also did not differ based on whether a surgery occurred on a surgeon’s birthday compared with other days.
> we found that patients who underwent surgery on the surgeon’s birthday were __similar in all observable characteristics__ to patients who underwent surgery on other days