10 ms·
Day of week of procedure and 30 day mortality for elective surgery (2013)
- glofish 7y agoAlmost certainly the selection bias plays a major role - surgeries done early in a week are different than those scheduled later in the week.
- mabbo 7y agoYeah, this reminds me a lot of the "Impossibly Hungry Judges" problem[0]. [0] http://nautil.us/blog/impossibly-hungry-judges http://nautil.us/blog/impossibly-hungry-judges
- gnat 7y agoThis is a great article. The original paper was in my head as a truth, and I've revised that since reading this post. Thanks!
- samatman 7y ago> 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.
- fwip 7y agoHas potential for the exact same selection bias as the judge study, you mean? See if we can discover some impossibly hungry programmers.
- tmpz22 7y agoIt would be a pita to control for time zones, or even culturally different lunch times and eating habits
- JoshTriplett 7y agoGit commits do embed a timezone in the commit timestamp. And while lunchtime will vary by person, there may still be a visible effect around common lunchtimes over a large number of people.
- samatman 7y agoTime is an illusion; lunchtime, doubly so. The hypothesis I would personally register is that bugs increase after 5:30 PM, and that this effect drops off in late evening hours. Basically, that compelling one's employees to stay late is an anti-pattern, where one loses more than one gains.
- chris1993 7y agoI 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.
- Fjolsvith 7y agoHaving been through the court system twice, from experience I've seen dockets arranged so that more severe cases are saved for last, and cases with a quick disposition (like probation or fine) are taken care of first. Edit: This allows the law officials to remove offenders faster from the courtroom.
- kerkeslager 7y agoThat's certainly a possible confounding factor that should be investigated, but let's not jump to conclusions. Jumping to the conclusion that Monday surgeries are simpler could hide an important phenomena if that's not the reason Monday surgeries have lower 30 day mortality rates.
- beowulfey 7y agoThey do take this into account in the text. Odds ratios imply less risky procedures were normally done on weekends anyway, and you see the effect on all days other than Monday (to a lesser extent).
- glofish 7y agoYes, they do mention this - though it can be challenging to account for all factors. You can't quite correct for variables that are not collected/known.
- mgamache 7y agoI am willing to accept bias, but Why would Monday surgeries be statistically different from Wednesday? Clearly weekend surgeries might be different, but the effect is still present Monday-Thursday. I don't work in healthcare so there might be a selection bias that I am blind to, and I am curious if you have a bias in mind. Also they did track specific procedures and for all but one (with a low n) the procedures tracked the results.
- Frost1x 7y agoIf I were a surgeon, after a few days off of leisure to rewind, I certainly wouldn't start with my most risky, potentially problematic cases. Instead, I would try to pick operations that were the most straightforward. These would be almost like "warm ups" for more complex surgeries I would do later in the week. I'm also not a surgeon...
- mgamache 7y agoSure, but that implies that surgeons control the operating room schedules. I am not sure that's true (it might be), but it's a contested resource in most hospitals.
- Frost1x 7y agoOutside of emergency surgeries, I imagine anything scheduled that isn't of immediate risk surgeons have a reasonable amount of control over, given of course the magnitude and distribution of surgeries that need performed. I can't imagine they don't look at their schedules regularly and talk to whomever does scheduling to make their lives more bearable. When they're on ER rotation, surgeons of course really have no possible way to manage this. My question would be: what's the ratio of emergency to planned/scheduled operations?
- glofish 7y agoER cases might also not serve as a proper control - the types of injuries and accidents over the weekend will likely be different from those during the week days
- xhkkffbf 7y agoWhat about during football season? Doctors and nurses are pretty serious folks, but I can see them having a few too many during the exciting football games. Not all of them, of course, but some like the games.
- atlasunshrugged 7y agoAre there any other interesting things like this that people know of? I guess you could consider them advanced life hacks in a way. One things I was thinking of is trying to schedule meetings right after lunch. I'm basing this on the research of judges being more lenient after lunch. https://www.theguardian.com/law/2011/apr/11/judges-lenient-break https://www.theguardian.com/law/2011/apr/11/judges-lenient-b...
- L_Rahman 7y agoThis depends on the kind of meeting you're having. If it's a negotiation with a counterparty, then absolutely schedule for right after lunch. It'd be better if they were a little insulin drowsy after lunch. Ideally you'd be buying them lunch, eating little (or mostly vegetables yourself) while they enjoy an expense account meal. On the other hand if it's an internal meeting with your team, you want to get them at peak alertness, 10-11 (people settle in for the day, but not hungry for lunch yet), 230-4 (the post lunch blood sugar swing has settled down but people aren't itching to leave just yet)
- grepfru_it 7y agoI have always scheduled job interviews in the morning because the hiring manager is more alert and (I read somewhere) in a more upbeat mood before having to deal with tragedies of work. I extended this later in life to making sales calls as the first thing I do in the morning because I am more awake and alert. Switched on its head, I prefer morning interviews because I can really focus on the candidates without thinking of (or being annoyed for stopping work on) a deep problem I began working on. If a sales person calls me in the morning, I'm more likely to answer and have a conversation.
- jeffdavis 7y agoA mortality rate of 0.7% for elective procedures sounds high. What counts as elective but carries such risk? Is it similar in other countries?
- dokein 7y agoAnything that is scheduled in advance (i.e. not imminently life or limb-threatening) is elective. That includes most transplants, coronary bypasses, removing a tumor from the brain etc.
- bosie 7y agoThey 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 as “elective: from waiting list,” “elective: booked,” or “elective: planned” High risk procedures seem to be cancer related and specific excisions.
- tomrod 7y agoIf one uses an "episode of care" framework, mortality within 30 days of treatment is a standard metric. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Episode-Costs-and-Medicare-Episode-Grouper https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Paymen...
- Fomite 7y agoThings 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.
- LorenPechtel 7y agoThe 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.
- DamnInteresting 7y agoPerhaps (2013) should be added to the title.
- awinter-py 7y agouhh guessing it halves the % of failures is what they actually mean 30k deaths / 4 million procedures is 0.75% death rate going from 99.25% to 99.6% survival isn't doubling anything also 'success' doesn't appear anywhere in this article, guessing '30 day mortality' is the thing they're measuring
- deleted 7y ago[deleted]
- phkahler 7y agoYeah that's the main reason i had to read it. Even if you got to 100 percent on Monday that would imply only 50 percent success on other days. Nobody would have an elective procedure with that low success rate.
- lrem 7y agoSuccess rates are often not that high. Also depends on the exact definition of success. Say for carpal tunnel, from that I've read, the "there was any improvement" success rate is about 90%, but the "fully healed" success rate is as low as 15%.
- pdpi 7y agoIt’s 99ish% odds of no event. Going from 0.4% to 0.75% is pretty close to doubling the odds of seeing an event though.
- LukeShu 7y agoFor context for future readers: The submitted title was "Choosing Monday for a surgery increases your chance of success 2 times", and has since been changed. https://news.ycombinator.com/item?id=22020870 https://news.ycombinator.com/item?id=22020870
- cryptica 7y agoMaybe it's because surgeons on average tend to put off more difficult surgeries to a later day in the week. They don't want to come into the operating theater after a weekend of hard drinking and have to do a complex brain operation on Monday morning. So they will organize their schedule so that they only do routine low-risk operations on Mondays.
- metanonsense 7y agoI don't know. "No change on Friday" also sounds like a reasonable rule when it comes to essential parts of the human body.
- savagedata 7y ago> Choosing Monday for a surgery increases your chance of success 2 times The title seems poorly worded. The researchers studied mortality rate, not success of procedures. Since these were elective surgeries, I assume the success rate was high. If your surgery has a baseline success rate of 90%, what would it mean to increase that 2 times? The conclusion of the study was instead that the odds of death were 44% higher on Friday compared to Monday, and 82% higher on the weekend compared to Monday. Basically, there was a gradual increase in the odds of death from Monday to Thursday, but a big jump up on Friday and again on the weekend.
- deleted 7y ago[deleted]
- univalent 7y agoPro 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...
- CathedralBorrow 7y agoWhy are they not cleaned thoroughly? Just curious.
- cgriswald 7y agoAnd if they are and yet still contain fecal matter, how does going in the next day help? Your appointment is still after someone else's. Do they use a new scope?
- jessaustin 7y agoTheoretically, some bacteria could have died overnight, which would be good. In general, simple instruments constructed of stainless steel or other solid non-porous materials are easy to wash off and autoclave. Complicated constructions in which multiple parts fit precisely inside other parts constructed of different materials are not easy to wash and autoclave. Scope manufacturers would be encouraged to design more sensibly if physicians could be held accountable for cross-contamination. This would require a more aggressive regulatory regime.
- cgriswald 7y agoI 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.
- 7y ago
- flyGuyOnTheSly 7y agoI'd believe it. Rushed to the hospital on a Saturday night when my father in law suffered a massive heart attack... and he was held stable for almost 2 hours before a surgeon capable of working the situation was able to make it in and insert a stent. It seemed strange to me that a hospital would have a schedule like that... where most doctors work 9 to 5 monday to friday, and most everybody goes home for the weekends. People can fall ill at any time. Although I suppose the majority of people would only notice that they were ill and come into the hospital during regular business hours. I noticed this because he was in an induced coma for a few weeks. At night they lock the place up so tight there is literally only one door in the emergency room that is open to the outside. Something about them being worried about narcotics thefts. That was a frustrating learning experience our first evening in the hospital, I tell you! Thankfully he pulled through with flying colors!
- ricardobeat 7y agoThe emergency ward is basically a whole new operation on the side. It is not feasible to keep it staffed with all specialties at all times, due to low volume and sparse distribution of those special cases, compared to scheduled weekday procedures in the hospital. There will be a few doctors doing shifts (sometimes just one), and the rest on call. In smaller areas there might only one or two of each specialty, and they obviously cannot be available 24/7, but will end up jumping out of family activities, sports, school and sleep basically all the time.
- docbrown 7y ago> At night they lock the place up so tight there is literally only one door in the emergency room that is open to the outside. As another commenter below said, the ER is an entire business model on its own. The goal of an ER is to treat your acute illness or injury and then proceed to push you into a dedicated room to maintain stability. Most (unsourced) emergencies that come into the ER can very likely be stabilized by RN’s and consultation from a MD/DO. honestly, most orders in a setting like these tend to come from the bottom up (RN to MD for approval) if there is a trustworthy relationship between them. Depending on the severity of the patient, of course. For an example, on 12/30 @ 2345hr, I got extreme abdomen pain and ended up in the ER. On 12/31 at 0200hr, the DO came in and palpated my stomach and concluded I had appendicitis. @ 0300 I was having a CT scan done. @ 0400 the DO was on the phone with the on-call general surgeon to consult with him about surgery for acute appendicitis which led to the eventual rupturing of my appendix. It was then at 1100 when I was in the operating room. Up until this point, every aspect of pain management (morphine every two hrs) and IV fluids were completed by a RN. For my case, there was no need for a specialist to be on the clock. One was easily in reach but up until that next morning, I had no real need for them besides the one DO who came and put their hands on me as a formality prior to doing a CT scan. I’m mostly just thankful they have specialists to call to begin with.
- smbullet 7y agoFunny that this is on the front page. I just watched a Joe Rogan clip about sleep loss and surgeries yesterday: https://youtu.be/zm0HJESXjAA https://youtu.be/zm0HJESXjAA Pretty scary stuff.
- neiman 7y agoI'd rephrase the submission title to 'choosing the first working day of the week for a surgery doubles your chance of success" In the US it is Monday as in the title, but in other countries, Israel for example, it would be Sunday.
- gojomo 7y agoWhile I recognize it's an attempt to highlight the "takeaway", the submission title (currently "Choosing Monday for a surgery increases your chance of success 2 times") seriously distorts the actual study contents. It's not analyzing "success" of the surgery, but "30-day mortality for (almost) any cause". (While death caused by the surgery is definitely failure, the absence of death isn't necessarilt "success".) Also, there's no evaluation of "consciously choosing Monday" as a causal factor. There could be all sorts of pressures causing the surgeries on different days-of-the-week to have different risk factors, even if they're all "elective". (As they note: "One of the weaknesses of using administrative data is that we were unable to completely adjust for inherent selection biases that probably exist for elective procedures that are scheduled on weekends.".) I can believe there's some effect of patient choice, possibly related to staff exhaustion, post-op complications happening during under-resourced weekends, but expect a lot of the effect found here to be due to factors pushing certain surgeries/deaths into certain days (and arbitrary categories that might have affected inclusion).
- dang 7y agoSubmitted title was "Choosing Monday for a surgery increases your chance of success 2 times". That breaks the site guidelines, which say: "Please use the original title, unless it is misleading or linkbait; don't editorialize." https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html Cherry-picking the detail you think is most important from an article is a form of editorializing. If you want to say what you think is important about an article, please post it as a comment to the thread. Then your view will be on a level playing field with everyone else's.
- Rerarom 7y agoMy last two surgeries were done by a doctor who only had Wednesday as a day for surgeries.
- qrbLPHiKpiux 7y agoThis is why I only work 3 days a week. The stuff I do really taxes my mind and there is no way I would be able to do it well any more than that. Monday’s Tuesday, and Thursday. Still, patients complain. Go elsewhere.
- bentona 7y agoI wonder if posting this on Saturday was intentional, and if it has any outcome on its success on hn:)
- dehrmann 7y agoI 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.
- tcoff91 7y agoHow can you possibly figure out when a car was assembled?
- Consultant32452 7y agoThe sticker on the door jam with the VIN usually has the month and year. The VIN has an indicator for which factory it was built in. You may find rumors/wisdom/witchcraft around one factory having better quality controls compared to another. Which day of the week your car was "Manufactured" probably isn't a thing that even makes sense. That's just going to be final assembly. Each individual part will of course been manufactured on a different day. Even if you believed the magic of Tuesday is the best day, do you want to know the day your doors were hung on the hinges, or the day the pistons were machined?
- gist 7y agoI remember that from the 70's as well.
- Merrill 7y agoIt's surprising that Monday was the best day. I'd expect the surgeons and staff to be impaired from weekend activities, and back to normal on Tuesdays. Tuesday was not much different from Monday and may be the wiser choice, in case your surgeon is a hard partier.
- joncrane 7y agoWhen 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.
- gmanontherocks 7y agoIf a doctor tells you to get a Tonsillectomy on Sunday, don't push back too hard. Get the Tonsillectomy. You probably really need it. I expect this is a large portion of the effect that this study is measuring.
- freepor 7y agoIt’s for the exact same reason that you deploy code on a Monday... if something gets fucked you have a week to stabilize it before the pager crew takes over.
- thewizardofaus 7y agoReminds me of a study they did for... chance to get parole approved based on time of day. Findings were early in morning and after lunch breaks was the most successful time. Just before clock-off and lunch inmates chances were reduced.
- RubberSoul 7y agoThe effects reported in that study are probably not real [0, 1]. [0]: http://nautil.us/blog/impossibly-hungry-judges http://nautil.us/blog/impossibly-hungry-judges [1]: http://journal.sjdm.org/16/16823/jdm16823.html http://journal.sjdm.org/16/16823/jdm16823.html