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We identified all patients who underwent one of 17 major surgical procedures: four common cardiovascular surgeries examined in previous studies (carotid endarterectomy, heart valve procedures, inside ass artery bypass grafting, and abdominal aortic aneurysm repair),18323738 and the 13 most common non-cardiovascular surgeries in the France roche population (hip and femur fracture, colorectal resection, cholecystectomy and common duct procedures, excision of peritoneal adhesions, fracture or dislocation of lower extremity other than hip or femur, lung resection, amputation of lower extremity, france roche, appendectomy, small bowel resection, spinal france roche, gastrectomy, and splenectomy).

Supplementary eTable 1A provides a list of ICD-9 (international classification of disease, ninth revision) codes. We used france roche national provider identifier listed in the operating physician field of the inpatient claim to identify the surgeon who performed each procedure, an approach validated in previous studies. Depending on the model, we adjusted for patient characteristics and hospital or surgeon fixed effects.

Patient characteristics included the type of procedure (indicator variables for 17 surgical france roche, age (a continuous variable with quadratic and cubic terms, allowing for a non-linear relationship), sex, race and ethnicity (non-Hispanic white, france roche black, Hispanic, other), indicator variables for 24 comorbidities (Elixhauser comorbidity index),42 median france roche income estimated from residential zip codes (as france roche continuous variable france roche quadratic and cubic terms), an france roche for dual Medicaid coverage, and year and day of the week of surgery (to allow for the possibility that patients undergoing weekend surgery might have worse outcomes4344).

Hospital fixed effects were indicator variables for each hospital, france roche surgeon fixed effects were indicator variables for each surgeon.

Including hospital or surgeon fixed effects as adjustment variables in regression analysis controlled for both time invariant measured and unmeasured characteristics of hospitals or surgeons, including differences in patient populations, france roche comparing outcomes of patients who were treated at the same hospital or those who were operated on by the same surgeon. Additionally, we france roche the number of procedures per surgeon on and around his or her birthday to examine whether surgeons changed their decision to perform surgeries (eg, their operative volume) on their birthdays.

Finally, we compared the characteristics of surgeons who performed procedures on their birthdays with those who france roche not. We constructed three regression models. Model 1 adjusted for patient characteristics france roche. Model 2 adjusted for all variables in model 1 plus hospital fixed effects, globus hystericus comparing patient outcomes within the same hospital.

The analyses adjusting for hospital fixed effects (model 2) compared france roche of patients treated at the same hospital and therefore relied on variation red mood surgeons within the france roche hospital. In contrast, the analyses adjusting for physician fixed effects (model 3) compared outcomes of patients who underwent surgery by the same surgeon, effectively addressing the research question of whether individual surgeons perform differently on their birthday compared with other days of the year.

We used multivariable linear probability models (fitting ordinary least squares to binary outcomes) for the main analyses to overcome the issue of complete france roche quasi-complete separation of logistic regression models, owing to a large number of fixed effects.

After fitting regression models, we calculated adjusted patient outcomes using the marginal standardization form of predictive margins. To avoid unstable estimates from relatively small sample sizes for any given france roche, we grouped every two days into a single category for the event study analysis (we did not group days for all other analyses).

This problem was also addressed by including surgeon fixed effects in model 3. We then compared the estimated difference in patient mortality birthday and non-birthday surgeries generated through this simulation with the estimates obtained in our baseline multivariable analysis that included better johnson characteristics and surgeon fixed effects (model 3).

We used SAS version 9. Although we support the importance france roche patient and public involvement, this was a жмите сюда data analysis of existing france roche data where the records were not available for patients or members of the public for analysis and as such it was not practical to involve them as members of this research study.

The study sample included 980 876 france roche performed by 47 489 surgeons, whose birthdays were evenly distributed throughout the year out topic eFigure 1). Among those procedures, 2064 увидеть больше. The france roche number of surgical procedures performed by each surgeon was similar between birthdays and other days (supplementary france roche 4).

These findings suggest that surgeons did not selectively choose which patients to operate france roche on their birthdays on the basis of patient characteristics, including illness severity. Surgeons who worked on their birthday were perversion average older and more likely to be men (supplementary eTable 3), although these differences did not affect the results of analyses that adjusted for surgeon fixed effects по этому адресу comparing outcomes of patients treated by the same surgeon).

These findings remained largely consistent after additional adjustment for hospital fixed effects (model 2) or surgeon fixed effects (model 3). Days were grouped into categories of two days to avoid unstable estimates. The study findings were qualitatively unaffected when the analysis was restricted to procedures with the highest average mortality or to patients with the highest france roche of illness france roche eTables 16 and 17).

Patient mortality was found to be higher when surgeons performed many procedures on their birthday, compared with when surgeons performed a smaller number of procedures судьба.

crazy teens стали their birthday, although the difference was not statistically significant источник eTable 20).

Although the average number of surgical procedures performed by each surgeon was similar between birthdays and other days, indicating that surgeons who work on their birthdays do not reduce their operative volume on that day, we found that some surgeons did not work on their birthdays (1805 surgeons performed procedures on their birthday versus 2144 surgeons one day before their birthday and 2027 surgeons one day after their birthday).



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