Surgeons’ birthdays may be linked to increased risk for patient death

Patients who undergo surgery on their surgeon’s birthday may be at a greater risk for mortality, according to a study published in BMJ.

Yusuke Tsugawa, MD, MPH, PhD, assistant professor in the department of health policy and management in the Fielding School of Public Health at UCLA, told Healio Primary Care that prior research has shown that patients have worse outcomes when they are admitted to hospitals on holidays or weekends. This may be caused by physician performance, but also because these patients may be sicker than average and because hospital staffing is not as sufficient on these days, he said.

“Our study was able to isolate the impact of these events on the performance of surgeons by exploiting the fact that patients usually do not know surgeons’ birthdays (and therefore, do not select when to undergo a procedure based on the information on a surgeon's birthday) and hospital staffing remains unchanged on surgeons’ birthdays,” Tsugawa said. “Our findings suggest that surgeons’ performance may be affected on their birthday, as indicated by a higher patient mortality compared to patients treated by the same surgeon on other days of the year.”

Tsugawa and colleagues conducted a retrospective observational study that included all Medicare beneficiaries aged 65 to 99 years who had a common elective surgery between 2011 and 2014.

They identified 980,876 procedures involving 47,489 surgeons, 0.2% (2,604) of which occurred on the performing surgeon’s birthday.

According to the researchers, the patients who underwent surgery on their surgeon’s birthday had similar characteristics — such as illness severity — to those who underwent surgery on other days.

Tsugawa and colleagues determined that the overall unadjusted 30-day mortality rate was 7% in those who had a procedure on their surgeon’s birthday and 5.6% in those who had procedures on other days.

After adjusting for various patient characteristics and surgeon-fixed events — an analysis of surgeons that compared surgery outcomes on their birthdays with other days they operated on — the researchers found that those who had a procedure on their surgeon’s birthday had a mortality rate of 6.9%, compared with a rate of 5.6% in those who had procedures on other days (adjusted difference = 1.3%; 95% CI, 0.1% to 2.5%).

According to researchers, this effect size — equivalent to a 23% increase in mortality — was similar to those seen in studies on outcomes after surgery on holidays like Christmas and New Year’s and over weekends.

One reason for increased mortality, they said, could be that surgeons feel they are under pressure and rush on their birthday more than on other days of the year because of evening plans. They also said that conversations about their birthdays with team members and receiving more messages could distract them.

The researchers wrote that their findings indicate that life events outside of work could influence surgeons’ performance.

“Further studies are necessary to understand why patients are experiencing a higher mortality on surgeons’ birthdays,” Tsugawa said. “If the underlying reason is due to irrelevant conversations and text messages in the operating room, hospitals can introduce policies that make sure that the operating rooms are kept quiet during the surgery. If time pressure is the major reason, hospitals can implement policies that encourage other surgeons in the same team to treat patients when surgeons have conflict in their schedule, such as birthdays.”