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[BMJ圣诞专刊]: 在外科医生生日接受手术患者的病死率:观察性研究
2020年12月26日 时讯速递, 进展交流 暂无评论

Research Christmas 2020: The Citadel

Patient mortality after surgery on the surgeon’s birthday: observational study

Hirotaka Kato, Anupam B Jena, Yusuke Tsugawa

BMJ 2020; 371: m4381(Published 10 December 2020) doi: https://doi.org/10.1136/bmj.m4381

Abstract

Objective

To determine whether patient mortality after surgery differs between surgeries performed on surgeons’ birthdays compared with other days of the year.

Design

Retrospective observational study.

Setting

US acute care and critical access hospitals.

Participants

100% fee-for-service Medicare beneficiaries aged 65 to 99 years who underwent one of 17 common emergency surgical procedures in 2011-14.

Main outcome measures

Patient postoperative 30 day mortality, defined as death within 30 days after surgery, with adjustment for patient characteristics and surgeon fixed effects.

Results

980 876 procedures performed by 47 489 surgeons were analyzed. 2064 (0.2%) of the procedures were performed on surgeons’ birthdays. Patient characteristics, including severity of illness, were similar between patients who underwent surgery on a surgeon’s birthday and those who underwent surgery on other days. The overall unadjusted 30 day mortality on the operating surgeon’s birthday was 7.0% (145/2064) and that on other days was 5.6% (54 824/978 812). After adjusting for patient characteristics and surgeon fixed effects (effectively comparing outcomes of patients treated by the same surgeon on different days), patients who underwent surgery on a surgeon’s birthday exhibited higher mortality compared with patients who underwent surgery on other days (adjusted mortality rate, 6.9% v 5.6%; adjusted difference 1.3%, 95% confidence interval 0.1% to 2.5%; P=0.03). Event study analysis of patient mortality by day of surgery relative to a surgeon’s birthday found similar results.

Conclusions

Among Medicare beneficiaries who underwent common emergency surgeries, those who received surgery on the surgeon’s birthday experienced higher mortality compared with patients who underwent surgery on other days. These findings suggest that surgeons might be distracted by life events that are not directly related to work.

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