Patient death rates higher on surgeons' birthdays

Patients who undergo surgery on the surgeon's birthday experience higher mortality compared with patients who undergo surgery on other days of the year, finds a US study in the Christmas issue of The BMJ.

These findings suggest that surgeons might be distracted by life events that are not directly related to work, say the researchers.

Laboratory experiments have shown that common distractions in the operating room, such as noise, equipment problems, and personal conversations, can have a detrimental effect on surgeons' performance, but evidence using real-life data is limited.

One theory is that surgeons might be more likely to be distracted or rush to finish procedures on their birthdays, so patient outcomes may differ on those days.

To test this theory, researchers used the nationally representative Medicare data of the elderly population in the US to examine death within 30 days after surgery for patients aged 65 to 99 years who underwent one of 17 common emergency surgical procedures at US hospitals in 2011-2014

This was linked to information on surgeon birthdays, and factors such as patient age and severity of illness, surgeon specialty, and hospital staffing levels were taken into account.

Overall, 980,876 procedures performed by 47,489 surgeons were analysed. Of these, 2,064 (0.2%) were performed on surgeons' birthdays.

Patients who underwent a surgical procedure on a surgeon's birthday exhibited higher mortality compared with patients who underwent surgery on other days (6.9% on birthdays vs. 5.6% on other days).

Though substantial, this is comparable to the impact of other events, including Christmas and New Year holidays and weekends, which have been argued to affect the quality of care patients receive, note the researchers.

What's more, results were similar after further analyses, such as excluding surgeons with the highest patient mortality and adjusting for timing of surgery, suggesting that they withstand scrutiny.

There are several possible explanations for these findings, note the researchers.

For example, surgeons may feel rushed to complete procedures on time on their birthday because they might have important evening plans. Birthday conversations with team members or birthday messages on their phones during surgery could also be distracting, leading to medical errors.

Or it may be that surgeons are less likely to return to the hospital to see their patients who show signs of deterioration if they are having dinner with family and friends, compared with regular evenings.

This is an observational study, so can't establish cause, and the researchers say they were unable to examine cause of death or exclude the impact of other unmeasured factors. The focus on common procedures in older Medicare patients also means that findings may not apply to other patient groups or surgical procedures.

However, taken together, these findings suggest that a surgeon's performance might be affected by life events that are not directly related to work, say the researchers.

While intuitive, this hypothesis has been otherwise difficult to assess owing to lack of detailed information on events that are potentially distracting to an individual surgeon, they conclude.