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Day of week of procedure and 30 day mortality for elective surgery (2013)

bmj.com

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Re: Day of week of procedure and 30 day mortality for elective surgery (2013)

#81

Post by chris1993 »

tmpz22 wrote: post #58
samatman wrote: post #11

Earlier quoted context omitted.

> If hunger had an effect on our mental resources of this magnitude, our society would fall into minor chaos every day at 11:45 a.m. ...this has potential! Scrape GitHub, find closed issues marked 'bug', do a blame on the offending line or lines, find the timestamp and plot.

It would be a pita to control for time zones, or even culturally different lunch times and eating habits

I read this as 'pita' as in 'pita bread'. A clever reference to lunch time if that was the intention? Culturally different too as we don't often eat pita for lunch here, but I imagine it's common elsewhere.

Re: Day of week of procedure and 30 day mortality for elective surgery (2013)

#82

Post by Fomite »

bosie wrote: post #18
jeffdavis wrote: post #8

A mortality rate of 0.7% for elective procedures sounds high. What counts as elective but carries such risk? Is it similar in other countries?

They aren't measuring the mortality rate of the procedure. they are measuring this: "Death in or out of hospital within 30 days of the procedure." If I am already on my death bed (for lack of better word), the procedure's mortality rate is probably not swaying it much. Also, couldn't find if they would include something like a lethal car accident 28 days after the procedure or not. > An elective procedure was defined…

Things like getting hit by a car are referred to as "competing risks". The authors lumped all deaths together: "We defined the mortality outcome as any death occurring within 30 days..."

But there are other ways to handle this, with increasing levels of annoyance/sophistication.

Re: Day of week of procedure and 30 day mortality for elective surgery (2013)

#83

Post by Fomite »

univalent wrote: post #20

Pro tip: if getting a colonoscopy, always always get the first appointment of the day. I work in med devices and ummm those scopes still have poop left over between procedures. Its not harmful, but still...

With the exception of an actual emergency (i.e. "We need to see inside them or they will die, we'll deal with the infection risk later) doing this in most hospitals I know is one of the better ways to sign up for the infection control team paying you a visit.

Re: Day of week of procedure and 30 day mortality for elective surgery (2013)

#84

Post by LorenPechtel »

jeffdavis wrote: post #8

A mortality rate of 0.7% for elective procedures sounds high. What counts as elective but carries such risk? Is it similar in other countries?

The problem is "elective" has a different meaning in doctor-speak than in common usage. "Elective" doesn't mean it's something you can reasonably decide to have or not, in doctor-speak it's the opposite of emergency. If it's put on the schedule rather than done stat it's elective, no matter how serious the procedure.

Re: Day of week of procedure and 30 day mortality for elective surgery (2013)

#85

Post by LorenPechtel »

univalent wrote: post #20

Pro tip: if getting a colonoscopy, always always get the first appointment of the day. I work in med devices and ummm those scopes still have poop left over between procedures. Its not harmful, but still...

If they're not being cleaned adequately report it to the medical board.

Re: Day of week of procedure and 30 day mortality for elective surgery (2013)

#86

Post by joncrane »

danbolt wrote: post #77
savagedata wrote: post #30

Earlier quoted context omitted.

The problem is with multiple-day recovery periods after the surgery. The later in the week your surgery is scheduled, the more likely you'll overlap with the weekend when care is hypothesized to be lower quality.

Part of me also wonders if people who elect to have Monday surgeries are in a better socioeconomic place to take more time off to recover.

I've had a bunch of surgeries and I wasn't given much of a choice as to when they were scheduled. These were orthopedic surgeries, but nothing urgent (stuff like a labrum repair or whatever). I was simply told to be at the hospital/surgery center at X time and that was that.

Re: Day of week of procedure and 30 day mortality for elective surgery (2013)

#87

Post by joncrane »

dehrmann wrote: post #66

I can't find a source, but 70's-era wisdom I got from my grandfather was when buying an American car, buy one assembled on a Tuesday. People are hungover on Monday, Tuesday is their best work day, it's downhill on Wednesday and Thursday, and they're checked out on Friday.

When I was a mechanic, we used the joke "must have been built on a Monday" when a car came back for repeated issues, but I think it was lighthearted humor at best. I'm not sure how much truth there was to it.

Re: Day of week of procedure and 30 day mortality for elective surgery (2013)

#88

Post by jessaustin »

univalent wrote: post #59
cgriswald wrote: post #56

Earlier quoted context omitted.

I am trying to make sense of the original post while stipulating that the claim about it not being harmful is true. Assuming only sterile fecal matter is left on the device, how does having an appointment the next day help? He seems to be suggesting that the fecal matter can be avoided by a gap of 16 hours versus a gap of (say) 30 minutes. I'm at a loss for the mechanism by which this might occur.

I work on the video side of things and know nothing about the mech eng part. What I can tell you is that during the day there is definitely fecal matter in the scope one case to another during the day after after autoclave and sterilization. The first case of the day, the scope is clean. I don't know what's different about overnight processing in the sterile processing department. And I've seen this at many hospitals…

The difference you cite between the per-patient and daily cleaning, disgusts any human who learns of it. The only studies showing that sort-of clean scopes are safe were funded by the scope manufacturers. This is problematic.
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