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The paper is the work of two physicians trained in internal medicine and a health economist, so they are free of bias as well asany practical knowledge about how surgeons operate, literally and figuratively. They made use of Medicare's dataset of beneficiaries and considered the 30-day outcome for surgery performed on a surgeon's birthday. They found 2064 operations (0.2%) of 980,000 procedures performed by 45,000 surgeons that were performed on their birthdays. With lots of variables to choose from, they compared the results of those 2064 to all the surgery on the other days, 978,000 give or take a few. They limited themselves to 17 procedures, four cardiovascular ones, and 13 of the most common non-cardiovascular procedures among Medicare beneficiaries. The endpoint, how many of these patients, undergoing emergency surgery, died within 30 days of surgery. [1]

They found

"The overall unadjusted 30-day mortality of patients on the surgeon's birthday was 7.0% (145/2064), and that on other days was 5.6% (54,824/978,812)."

To be fair, they tested many variations and adjustments to make sure that they were comparing apples to apples and found a 1.6% increase in mortality for those patients, even with adjustments. For the mathematically inclined, you could say that emergency surgery on your surgeon's birthday was associated with a 29% greater risk of dying or 30 excessive deaths. You should also know that this was over three years, so we are talking about ten excess deaths per year.

Much of the article's red-meat is alluded to in the text but found in the supplements that accompany the article. Let me share some of my favorite findings:

My favorite part, though, was the connect the dots section, labeled discussion. What could have caused this to happen, other than finding a pattern in random data after careful statistical magic? The answer is the distracted surgeon. Included in their list of possible distractions,

These last two possible distractions get at an even bigger problem with the paper, none of the authors know anything about surgical care's practical realities. The heartbreaking problem is that this peer-reviewed paper will now wander in the medical literature and undoubtedly gather citations enforcing the concept of the distracted surgeon, too enamored with their upcoming birthday celebration to pay attention to caring for the life in front of them. It is demeaning. That it would be picked up by the media and further publicized is demoralizing.

[1] Deaths, as a result of surgery, has multiple definitions. They can refer to deaths while hospitalized within the 30-day interval or during the hospitalization irrespective of its length. It can refer to deaths only in the hospital or those at home.

Source: Patient mortality after surgery on the surgeons birthday: observational study BMJ DOI:10.1136/bmj.m4381

The rest is here:

Are Surgeons More Likely To Kill You On Their Birthday? - American Council on Science and Health