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Thu May 8, 2014
Study: Time Away Can Hurt Surgeons' Job Performance
STEVE INSKEEP, HOST:
This next story begins with an old saying among musicians: If I miss one day of practice, I notice it. If I miss two days, the critics notice it. If I miss three days of practice, the audience will notice. A study found evidence that saying applies to surgeons, and lives may be at stake.
NPR's Shankar Vedantam has been looking at the results of that study. He's in our studios. Hi, Shankar.
SHANKAR VEDANTAM, BYLINE: Good morning, Steve.
INSKEEP: What was the research?
Well, let me set the stage for you. This was an analysis conducted by Lorens Helmchen. He's a researcher at George Mason University. And along with his coauthor, Jason Hockenberry, they got hospital and discharge records for more than 56,000 patients who got a heart bypass surgeries.
VEDANTAM: And the researchers compared the outcomes of patients in two different groups. In the first group, the patient's surgeon had performed surgery on other patients the previous day. In the second group, the patient's surgeon had not performed surgery the previous day.
INSKEEP: They had a weekend, vacation, whatever.
VEDANTAM: Exactly. Now there are three possible outcomes. One, that the surgeons are so skillful at the break makes no difference whatsoever. The second possibility -which is what I would have picked - is that the surgeons are actually going to be better when they come back from vacation because they're going to be refreshed.
VEDANTAM: Helmchen told me that he was interested in the third hypothesis. Here he is.
LORENS HELMCHEN: If you've just come back from a long weekend, you may have forgotten a few details when you perform the procedure. And you may also a little rusty with your fingers. Our hypothesis was that the outcomes would be worse.
INSKEEP: Which hypothesis turned out to be true?
VEDANTAM: Well, unfortunately, it was the third hypothesis, Steve. The outcomes were worst when the doctors had not practiced surgery the previous day. I want to be very clear, the difference is very small. In fact, it was so small that an individual doctor or even an individual hospital probably would not notice the difference. And I asked Helmchen to describe the size of the effect that he found.
HELMCHEN: If you take 100,000 heart bypass surgery patients, of those about 2700 die before they just charged from the hospital. Our study suggests that every additional day that the surgeon was away from the operating room increases that number by an additional 70 patients.
INSKEEP: Whoa. So if they had a day off, there's a tiny difference. If they had a couple days off, there's a little bigger difference. If they had a two-week vacation or a month-long sabbatical, there's a big difference.
VEDANTAM: Yes. Now it's important to remember that the data doesn't really allow us to parse those differences in great detail because it's not as if most surgeons are taking huge amounts of time all the time. But it does seem to be cumulative, which is that the longer the time off, the bigger the effect.
INSKEEP: So what's happening here? Is it just Monday morning blues? People aren't focused enough when they come in on their first day back?
VEDANTAM: It could be a bunch of different things, Steve. One could be that the surgeons indeed, are losing a little bit of dexterity, like the musicians, and so that's showing up in the outcomes.
INSKEEP: Oh, like in that saying. Right.
VEDANTAM: Exactly. It could also be that the surgeons are doing fine during surgery, but they're missing potential complications. Helmchen and Hockenberry find that when surgeons come back from a break hospital costs go down. So it could be surgeons are ordering fewer tests or not thinking about very rare risks. There's another possibility, which is it might have to do with the team surrounding the surgeon and on the first day back, the team is still sort of getting its act together or getting its edge together and they're not quite as good as they were when they've had several days of practice.
There's a final explanation, and this is completely innocuous, which is the hospitals are lining up the sickest patients when the surgeons come back first, but because they're so sick they're more likely to die.
INSKEEP: OK. So whatever the explanation, Shankar, you've got this tiny additional risk of death if you have surgery on the surgeon's first day back. And they are people who are going to be thinking about that right now. Should they avoid scheduling their surgery on a Monday?
VEDANTAM: Well, I'm not sure that will be exactly the right advice, Steve because, of course, we don't know exactly what's driving this. I think the better message to take away is that hospitals need to look at this data and say there could be something here that would allow us to improve our outcomes. It could be that there are techniques that surgeons can practice before coming back that would address the dexterity issue.
INSKEEP: Like finger exercises for like musicians.
VEDANTAM: Exactly. It could be a teamwork exercise the team needs to do. It's possible that hospitals actually have the answer hidden somewhere in their data. They actually need to look at their own discharge records more closely. I think every explanation starts however, with trusting the data and not trusting our intuitions about these outcomes.
INSKEEP: Shankar, thanks as always.
VEDANTAM: Thank you, Steve.
INSKEEP: NPR social science correspondent Shankar Vedantam, you can follow him as always on Twitter @Hidden Brain. You can follow this program @MORNING EDITION, @nprgreene and @nprinskeep.
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INSKEEP: It's MORNING EDITION from NPR News. Transcript provided by NPR, Copyright NPR.