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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

#201

Post by FabHK »

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.

Suboptimal. The "NOT" might be covered by something, and then what remains is "THIS LEG". I would have written "NO NO NO" on one leg, and "THIS THIS THIS" on the other.

In aviation, standard phraseology is generally carefully designed such that (mosts) subsets of a phrase are distinct from the opposite phrase. For example, when ATC warns of traffic, you reply either "traffic in sight" or "negative contact". When ATC hears only half of either, they still know what you meant.

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

#202

Post by FiatLuxDave »

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…

I wonder if you would be interested in the discussion in this recent HN thread regarding intubation (or it might all be old hat to you):

https://news.ycombinator.com/item?id=25395314

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

#203

Post by FabHK »

throwaway2245 wrote: post #135
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

One of the studied showed that teams that completed the checklist had lower mortality, but argued that the teams completing checklists might be systematically different from the teams that didn't complete the checklists, and thus the difference could not be attributed to the checklist, per se. Not wrong, but doesn't amount to refutation.

Note that in the debate you cited both, proponent and opponent, advocated the (continued) use of checklists.

Side note: I could see how you could do a blinded RCT, but not how you could do a double blind RCT here.

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

#204

Post by nkurz »

FabHK wrote: post #195
colonwqbang wrote: post #84

Earlier quoted context omitted.

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…

You could control for patient characteristics (age, severity of the condition, etc), and that was indeed done here, see the paper. It also specifically addresses this issue: > 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 unli…

This is a great point to raise, but it's worth noting that it directly contradicts the GP's anecdotal observation. Had they instead found greater severity on birthdays and attempted to statistically correct for it, the two would be compatible. Instead, they looked, and found that there was no underlying difference to correct for. The question then becomes whether the GP is wrong, whether the hospital in question didn't have such a policy, or whether the measurements used in the study were insufficient to pick up the difference in severity.

I don't know which of these is true, but despite the apparent statistical significance of the finding, I wouldn't be confident assuming that the result is generally applicable. While not impossible, it strikes me as suspicious that they found no differences whatsoever in the surgeons' birthday vs non-birthday schedules. I somewhat wonder if by "no difference" they really meant "no statistically significant difference", which in this case wouldn't justify their lack of adjustment.

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

#205

Post by boomboomsubban »

helsinkiandrew wrote: post #108
boomboomsubban wrote: post #55

Earlier quoted context omitted.

I may be making this up, but aren't there some rather strict rules about surgeons and alcohol? It may make them more likely to just take the day off.

I'd guess that few surgeons start boozing at breakfast on their birthday or have a lunchtime drinking session to celebrate. But are more likely to be rushing off to have a party than actually be impaired.

I more thought you might need to request the day off to avoid being on call, surgeons have very unstable hours.

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

#206

Post by waterhouse »

nkurz wrote: post #204
FabHK wrote: post #195

Earlier quoted context omitted.

You could control for patient characteristics (age, severity of the condition, etc), and that was indeed done here, see the paper. It also specifically addresses this issue: > 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 unli…

This is a great point to raise, but it's worth noting that it directly contradicts the GP's anecdotal observation. Had they instead found greater severity on birthdays and attempted to statistically correct for it, the two would be compatible. Instead, they looked, and found that there was no underlying difference to correct for. The question then becomes whether the GP is wrong, whether the hospital in question didn…

Furthermore, note that there really is a significant "avoiding surgeries on birthdays" effect: 2064 in 980,876 operations were done on a birthday, which is 1 in 475, rather than the 1 in 365 if there were no such effect. That's a reduction of 23%, which is rather suspicious given that we're trying to explain a 23% increase in mortality rate.

So what mechanism is responsible for that reduction, and is it likely to affect surgeries differently based on how urgent and specialized (and therefore dangerous) they are? Since the authors restricted it to surgeons that have done at least one surgery on their birthday, that rules out blanket "never on birthday" policies. It seems like the only mechanism that wouldn't affect them differently is "the surgeon is already on vacation in another country and can't get here for the operation" (and they choose to take vacations on their birthday more frequently). One could probably check vacation-day records relatively easily...

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

#207

Post by throwaway2245 »

someburner wrote: post #143
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 just got surgery in California and noticed I was asked to state my name and birthday anytime I moved rooms or saw a new person. Seems like this is now part of protocol in a lot of places.

I've moved from a place where the protocol is "what's your name/birthday?" (while looking at a form with my name/birthday on it)

to a place where the protocol is "are you [name]?"

The difference is unnerving.

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

#208

Post by cloverich »

Raphmedia wrote: post #184

I 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…

Just a note, this (and many) titles report _releative_ change as the percentage. E.g. 1% -> 1.5% report as "50% increase". It is IMHO very misleading. At one point I developed a gut reaction to any statistic "Relative or absolute".

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

#209

Post by Dylan16807 »

kkoncevicius wrote: post #113
Dylan16807 wrote: post #85

Earlier quoted context omitted.

> Then it would be almost guaranteed that such a finding is spurious. But that's the fallacy. You can't just preemptively assume that there are no real correlations. You definitely want to use a smaller p threshold when you look for more things, but it's quite possible to hit real correlations with a pile of plausible hypotheses. As an example: Let's say just 1/150 of your hypotheses hit a real correlation, and you'r…

> [...] but it's quite possible to hit real correlations with a pile of plausible hypotheses. Yes of course. But the trouble is that, if you do this p-hacking expedition, you are guaranteed to find those correlations in pure noise. So if you use a procedure that will find something in noise - you cannot also use it to claim to have found something in your data. In the words of statistics philosopher Deborah Mayo - "A…

> In the words of statistics philosopher Deborah Mayo - "A conjecture passes a test only if a refutation would probably have occurred if it's false".

Sure, one weak result out of many doesn't pass. But not passing is a far cry from "almost guaranteed" to be spurious.

> Hence - the result is equivalent as if no test has actually been performed.

A result like that takes a big list of plausible correlations and distills it down. If you think even a handful of the original list items are likely to have merit, then the distilled list is useful for suggesting where you should collect more data.

> Or, a more simplistic example, imagine if someone observes an asteroid and says "it might be aliens".

What fraction of asteroids to you expect to be aliens?

If it's one in a billion, then cutting the list by a factor of 20 is useless. If it's one in a hundred, then cutting the list by a factor of 20 is very helpful.

> I feel that the same is true for "yeah, but the correlation might still be true".

It depends on the original list being sufficiently plausible. You can't distill tap water into vodka.

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

#210

Post by throwaway2245 »

FabHK wrote: post #203
throwaway2245 wrote: post #135

Earlier quoted context omitted.

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

One of the studied showed that teams that completed the checklist had lower mortality, but argued that the teams completing checklists might be systematically different from the teams that didn't complete the checklists, and thus the difference could not be attributed to the checklist, per se. Not wrong, but doesn't amount to refutation. Note that in the debate you cited both, proponent and opponent, advocated the (c…

I think checklists are probably just fine, but I think they are overhyped despite a lack of scientific comparison to other interventions (I would much rather have sharpie on my legs and barcodes on the surgical sponges, given the choice) - and in particular, checklists are not directly relevant to the content of this article.
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