US study finds patient death rates higher on surgeons’ birthdays

Patients who undergo surgery on their surgeon’s birthday are less likely to survive than those who go through surgery on other days of the year, according to a new US study published in the British Medical Journal (BMJ).

Researchers found surgeons were more likely to be distracted by life events that are not directly related to work on their birthday, including dinner plans and birthday conversations with team members.

They theorised that surgeons might be more likely to be “distracted or rush to finish procedures on their birthdays” and so patient surgical outcomes may differ on those days.

Researchers tested their theory using nationally representative medicare data of older Americans aged 65 to 99 years who underwent one of 17 common emergency surgical procedures at a US hospital between 2011 and 2014 and by examining the mortality rate within 30 days of the surgery.

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The patient’s age, severity of their illness, the surgeon’s speciality and hospital staffing levels were also taken into account during the study.

Of the 980,876 procedures performed by 47,489 surgeons which were examined, 2,064 (0.2 per cent) were performed on surgeons birthdays.

Researchers found some 6.9 per cent of patients who were underwent surgery on their surgeon’s birthday died within 30 days compared to 5.6 per cent who went through surgery on other days.

They noted the results were comparable to the impact other events, such as Christmas and New Year, have on a patient's care and cited the case of Scotland, where people who were admitted to hospitals on public holidays for emergency care showed a 27 per cent increase in 30-day mortality.

However, the use of surgeons’ birthdays as a “natural experiment” is a better indicator than other distracting events given that Christmas and New Year’s may also affect a patients’ decision to seek care and hospital staffing levels, it noted. In contrast, the patient mix and hospital staffing are at normal levels on a patient’s birthday, said the study.

Explanations

Researchers noted several explanations for these findings, including the fact that surgeons may feel rushed to complete procedures on time on their birthday because they have evening plans. Birthday conversations with team members or birthday messages on their phones during surgery could also be distracting and lead to medical errors, said the study.

Surgeons may also be less likely to return to hospital to see their patients who are showing signs of deterioration if they are having dinner with family and friends on their birthday, added researchers.

As this was an observational study, researchers were unable to examine the cause of death or exclude the impact other factors played in a person’s mortality, notes the study. The focus on common procedures among older patients means findings might not apply to other patient groups, it adds.

However, this study suggests “a surgeon’s performance might be affected by life events that are not directly related to work”.

The study also noted that lab experiments had shown common distractions in operating rooms, such as noise, equipment problems and personal conversations, can have a “detrimental effect” on surgeons’ performance. However, evidence of this using real-life data is limited.

The BMJ observational study was published on Thursday as part of the BMJ’s annual Christmas issue which mixes “quirky comment articles, light-hearted features and peer reviewed original research”.

However, the journal underlined that it does not publish “spoofs, hoaxes or fabricated studies”, adding that papers in the Christmas issue adhere to the “same high standards of novelty, methodological rigour, reporting transparency and readability” as regular articles.