Then there are studies looking at particular procedures. Four thousand patients had emergency surgery for acute appendicitis in two American teaching hospitals between 1998 and 2007. They fared no worse in July and August than in any other month. Another Canadian study looked instead at children having surgery to insert tubes into their spines to divert cerebrospinal fluid. Here there was an advantage, although only a slight one, in going to hospital at a time of year other than July and August because the tubes lasted longer before needing to be replaced and there were fewer complications. This might suggest that better supervision is needed during procedures such as this when the doctors are new to the job.

Several other studies found that July and August was no more risky a time to be in hospital than at any other time year. But there was one study which was more worrying. It concentrated on surgery in teaching hospitals and they did find a lower survival rate in July and August than during the rest of the year. Some elements of the study, however, made it hard to know whether the extra deaths were down to the trainee doctors. The study made sure there was the same amount of emergency surgery included in each time frame.

But they couldn’t control for the fact that because a lot of patients and doctors are on holiday in July and August, more routine cases are often delayed, so the doctors could be left with the more serious semi-urgent cases during these months, and they are the kind of cases more likely to experience complications.

Winter death rise



They did collect some interesting data on the length of time it took for staff to prepare a patient for surgery and found that in July and August operations took an average eight minutes longer from the time of the first incision to the time of putting the dressing on at the end of the surgery. This isn’t dangerous, but might indicate that they were struggling more with the procedure. Or could it just indicate that they were new to the job and were taking the time to make sure it was done properly?

In this study the numbers of deaths did rise again in winter, which is commonly seen. There are various reasons for this. Blood pressure can be higher when it’s cold and there are more viruses and bacteria spreading around the community. This can be enough to lower survival rates in hospital.