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If you do need surgery, you should take comfort in knowing that researchers have been studying the factors that predict the success or failure of surgery for years. Some of the most important findings are the ones you might expect.
For example, studies have shown that hospitals and medical centers that perform many hip and knee replacements tend to have lower complication rates than those that perform fewer operations. Therefore, there is a trend for people who need these surgeries to have them performed in high volume centers. Likewise, surgeons who frequently practice hip or knee replacement surgery tends to have better results than those who do it infrequently. Studies like these have been published for a number of other operations and conditions.
Less obvious factors to consider when planning surgeries
You may be surprised to learn that less obvious factors have also been investigated. For example, the researchers examined whether
- surgical outcomes are worse in teaching hospitals in July, when new medical and surgical trainees begin (a phenomenon known as the “July effect”). The results are mixed: some studies find it is true and others demystify the idea.
- music played in the operating room – including loud or soft, classical or upbeat, or no music at all – is helpful or harmful. Again, the the evidence is mixed.
- surgical success may vary depending on the dominant hand of your surgeon. In a study of cataract surgery, patients operated on by left-handed trainees had fewer complications than those operated on by right-handed trainees.
Another surprising surgical study: birthdays
A new study published in the medical journal the BMJ tried to answer a question I would never have thought to ask: if a surgeon performs an operation on his birthday, does it affect his patient’s chances of survival?
Put aside for a moment Why these researchers thought it was a valid research question, let’s look at how the study was done and what the researchers found. They analyzed survival data from nearly one million emergency operations performed by more than 47,000 surgeons in the United States between 2011 and 2014. All patients were at least 65 years of age and underwent one of the following. 17 common emergency operations, such as coronary artery bypass surgery or gallbladder removal. . Although emergency surgeries are not planned, depending on the situation, they may not have to be performed on the day of diagnosis.
The study found that more patients died within one month of surgery when the operation was performed on the surgeon’s birthday (6.9%) than on other days of the year (5.6 %). The difference was statistically significant and did not appear to be due to some other explanation the researchers could identify, such as whether
- surgery dates were moved a bit sooner or later depending on the surgeon’s birthday
- a small number of surgeons may have had high complication rates which could skew the results
- there were variations in surgical complexity, frequency or type
- surgeons may have deliberately avoided performing surgery on their birthday
- birthdays were “big” (like turning 60) or fell on a weekend.
Statistical methods have been applied to reduce or eliminate the possible impact of each of these potential explanations. Interestingly, no effect of the surgeon’s birthday was found for planned (elective) surgeries.
Why would the success of surgery depend on the surgeon’s birthday?
It is fair to wonder if there is a plausible explanation for how a surgeon’s birthday might affect the success of surgery.
The study’s authors suggest that the results demonstrate how “surgeons could be distracted by life events.” but what does that mean? Were the surgeons less focused? Were they rushing the surgery to come home earlier to start celebrating? Did the excitement of their birthday in any way affect the physical performance of the surgery? All of these potential explanations (and perhaps others you could suggest) are speculative, since the study did not focus on Why the results were observed.
The bottom line
It is tempting to dismiss the results of this study as “don’t believe everything you read”. After all, this is only one study and there is no convincing or obvious way to explain the results. And it doesn’t seem practical for someone in need of emergency surgery to try to find out when their surgeon’s birthday is and, if it’s surgery day, to ask another surgeon.
Then again, it could be argued that until we know more, perhaps emergency surgeons’ on-call schedules should be adjusted to avoid postings on a surgeon’s birthday. Patients might have slightly better results, and the surgeon might have something really special on their birthday: a day off from surgery.
Follow me on twitter @RobShmerling
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