Patient Mortality Higher When Surgeons Operate on Their Birthdays

By Linda Carroll

December 15, 2020

(Reuters Health) - Patients who undergo procedures on their surgeon's birthday are more likely to die within a month than those who have surgery on other days of the year, a new study suggests.

In the analysis of nearly one million procedures, 2,064 performed on a surgeon's birthday, the adjusted 30-day mortality for patients who had a procedure on the surgeon's birthday was 6.9%, as compared to 5.6% when the surgery was on a different day, according to the report published in The BMJ.

"Surgeons are humans, so they can be distracted by a lot of different reasons," said study coauthor Dr. Yusuke Tsugawa, an assistant professor of medicine at the David Geffen School of Medicine at the University of California, Los Angeles. "A better understanding of the factors that affect the performance of surgeons is important to understand to make sure all patients get high quality care regardless of when they get sick."

Does this mean that hospitals should give all surgeons their birthdays off?

"If it were possible, it might be a good option for surgeons to take their birthdays off," Dr. Tsugawa said. "But the reality is that most institutions need enough surgeons working each day. Alternatively, we could think about potential mechanisms that explain why patient outcomes might be worse on a surgeon's birthday."

It could be that some scheduling tweaks might be all it would take to fix this problem.

"For example, the surgeon might be under high time pressure to complete the procedure and leave by the end of the day," Dr. Tsugawa said. "So, surgeries completed at the end of the day might be at a higher risk than those performed in the morning."

Other studies have suggested higher mortality rates might be related to the particular day of the week a surgery takes place, Dr. Tsugawa said. "There have been multiple studies showing worse outcomes on weekends, Christmas and Thanksgiving," he said. "But it's possible that on those special days, there might be differences in the patients who show up, or in the number of staff on duty. Our study tried to isolate the impact of surgeons."

To explore whether surgeon birthdays might impact patient outcomes, Dr. Tsugawa and his colleagues analyzed the records from 100% of the Medicare fee-for-service beneficiaries aged 65 to 99 treated at acute care and critical access hospitals between 2011 and 2014. To minimize potential selection bias, the researchers focused on emergency procedures.

In their final analysis, the researchers adjusted for a host of patient characteristics, including age, gender, race/ethnicity and median household income estimated from residential zip codes. They also adjusted for surgeon fixed effects.

The study sample included 980,876 procedures performed by 47,489 surgeons, whose birthdays were evenly distributed throughout the year. Among those procedures, 2,064 (0.2%) were performed on surgeons' birthdays.

Among the study's limitations, the authors note, is the remaining possibility of unmeasured confounding. In particular, they write, it is possible that despite showing comparability of patients on the basis of a range of patient characteristics, surgeons might postpone less-severe cases and operate on only the most-severe cases on their birthdays.

The researchers also lacked data on causes of death, as well as detailed clinical information that might shed light on the mechanism of increased mortality, they write.

SOURCE: The BMJ, online December 10, 2020.