tag:blogger.com,1999:blog-4968787219619380438.post2829484681730849378..comments2023-09-21T04:02:29.457-04:00Comments on Skeptical Scalpel: Operative Mortality Rates and Sleep DeprivationSkeptical Scalpelhttp://www.blogger.com/profile/13206922456661320751noreply@blogger.comBlogger6125tag:blogger.com,1999:blog-4968787219619380438.post-11357322619287850312011-09-21T04:52:57.932-04:002011-09-21T04:52:57.932-04:00Now, if the surgeon tied the ventricles off with a...Now, if the surgeon tied the ventricles off with a bog standard surgeon's knot, installed stents like mad (ordering spares) and perforated the central line thrice, that's when the anesthetist tells her she's tired. If you want a natural experiment, you'd pick the boggy things (Proctology, put your hand down) like bile sac troubles, suppurations, maybe spleen or kidney injury; or shoulder surgery with insertion repair (test test test!)Obsinguodhttps://www.blogger.com/profile/00608098009867280297noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-49231719855517308662011-08-09T17:03:55.258-04:002011-08-09T17:03:55.258-04:00@Anonymous
Thanks for the comment. I have not see...@Anonymous<br /><br />Thanks for the comment. I have not seen a study that shows worse outcomes with reduced working hours. There are no good studies comparing reduced hours to more frequent hand-offs and there probably won't be.<br /><br />NY Times had an interesting article about this (http://is.gd/3iadAZ)suggesting that hand-offs may be more of a problem.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-9836304244482067362011-08-08T16:56:31.363-04:002011-08-08T16:56:31.363-04:00A quick google.
http://www.nejm.org/doi/full/10.1...A quick google.<br /><br />http://www.nejm.org/doi/full/10.1056/NEJMoa041404<br />http://www.nejm.org/doi/full/10.1056/NEJMoa041406<br />http://www.bmj.com/content/336/7642/488.abstract<br />http://jama.ama-assn.org/content/298/9/984.short<br /><br />Have seen other studies show no change in patient outcomes from reduced hours. Do any show worse patient outcomes from reduced hours?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-58952014788420816952011-07-11T10:32:36.196-04:002011-07-11T10:32:36.196-04:00@Thirsty
I apologize for missing your comment for...@Thirsty<br /><br />I apologize for missing your comment for over a month. Maybe I was tired :-)<br /><br />I don't know of any research regarding experience vs. the effect of sleep-deprivation. It's a great idea for a study.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-70670781054455078582011-06-08T11:18:29.108-04:002011-06-08T11:18:29.108-04:00If there were an effect of timing / fatigue on per...If there were an effect of timing / fatigue on performance, I would expect to see it most in the surgeons who were the least trained / least experienced (a la the paper from last year that showed that patients operated on by residents had more morbidity but less mortality ... I don't recall the exact details). I wouldn't expect transplant surgeons (often fellows or attendings) or senior attending cardiothoracic surgeons (6-7 year training + multiple years on staff) to be nearly as susceptible to fatigue and/or error.<br /><br />That data (relative experience of the operating surgeon) seems like it might be difficult to come by. Do you know of a decent proxy for this? For instance, teaching hospital appy's in July (PGY-2's going into the OR ...)? Just thinking of ways to exploit natural experiments to test my hypothesis.<br /><br />If there is a good natural experiment, maybe I'll write it up as a research proposal at University Med School ...<br /><br />-TSThirstyhttps://www.blogger.com/profile/16112748581588448637noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-5299623397139062722011-06-08T10:51:11.138-04:002011-06-08T10:51:11.138-04:00Don't give me definitive studies that contradi...Don't give me definitive studies that contradict my instincts! I want my doctors to get 8 hours of sleep immediately before any operation I have! And they should also do yoga and get massages. But I don't want to pay any extra for any of this. (sarcasm)Vickie@Demand_Euphoriahttps://www.blogger.com/profile/17706946767924290485noreply@blogger.com