目的

确定在外科医生生日当天进行的手术与一年中其他日期进行的手术之间患者术后死亡率是否有差异。

设计

回顾性观察研究。

场所

提供紧急照护的医院

参与者

100%按服务收费的医疗保险受益人，年龄在65岁至99岁之间，在2011-14年间接受17种常见急诊外科手术中的一种。

主要观察指标

患者术后30天死亡率，定义为术后30天内死亡，根据患者特点和外科医生的固定效果进行调整。

结果

分析47 489名外科医生完成的980 876例手术。2064例(0.2%)手术是在外科医生生日当天进行的。在外科医生生日当天接受手术的患者和在其他日子接受手术的患者的特征（包括疾病的严重程度）是相似的。手术外科医生生日当天的整体未调整30天死亡率为7.0%(145/2064)，其他天数为5.6%(54 824/978 812)。在调整患者特征和外科医生固定效应(有效比较同一外科医生在不同日期治疗的患者结果)后，在外科医生生日当天接受手术的患者比在其他日子接受手术的患者表现出更高的死亡率(调整后死亡率为6.9% vs 5.6%;调整差值1.3%，95%置信区间0.1% ~ 2.5%;P = 0.03)。对手术天数与外科医生生日相关的患者死亡率的事件研究发现了类似的结果。

结论

在接受普通急诊手术的医疗保险受益人中，在外科医生生日当天接受手术的患者比在其他日子接受手术的患者死亡率更高。这些发现表明，外科医生可能会被与工作没有直接关系的生活事件分心。

 

 

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.

原文链接：

https://www.bmj.com/content/371/bmj.m4381