Why you shouldn’t get surgery on a surgeon’s birthday 🎂
Sometimes celebrations are not in order.
Hello and welcome to Careviser by Marie Loubiere, the weekly newsletter that cuts through the healthcare noise with a single focus: productization of the latest research and tech breakthroughs.
As some of you know, I worked for three years for caresyntax, one of the leaders of surgical AI, analytics and visualization software. Surgery is probably one of the areas in healthcare I am the most knowledgeable about.
Why am I so passionate about surgery? 🏥
It matters: when you go through surgery, it means something serious happened to you. I fondly remember the first time I stepped in an OR a few weeks after I joined caresyntax in 2016. The silence. The dimmed lightning. The surgeon, the residents, the OR nurses. The surgical tools. And the patient asleep on the OR table. It felt like I was in a movie. I was hooked. And I spent entire days hanging out in operating theatres in the following years. Watching surgeries, and learning how tech and optimized workflows can make a difference.
It is huge: hospitals generate most of their income from surgical procedures.
It is still untapped in terms of operational optimization and technology.
A quick ask for my French 🇫🇷 readers: do you know a GP, a midwife or an ob-gyn physician that is Paris-based and interested in new ways to deliver primary gynecology care?
I would love to chat with them!
Patient mortality after surgery on the surgeon’s birthday: observational study by Kato Hirotaka, Jena Anupam B, Tsugawa Yusuke
🗝️ Why it matters: Up to 30% of patients experience complications after surgery, and up to 10% die as a result. It has been estimated that about half of complications and up to 40% of deaths could be preventable. That’s a lot of deaths and complications that could be avoided!
🔎 Current knowledge on surgery quality: Outside of healthcare, there is a wealth of research that shows that distractions affect people’s decision making (from whether their favorite sports team won a game recently to the outside temperature). However it has been challenging to investigate the impact of distractions on the quality of surgical care. Birthdays present a unique opportunity to do so as they are a very straight-forward piece of information about the operating surgeon that researchers can gather.
🧾 Findings: Researchers analyzed almost 1 million common surgical procedures performed on Medicare patients aged 65 to 99 years between 2011 and 2014. 0.2% of such surgeries were performed on the surgeon’s birthday.
30 days after surgery, patients who underwent surgery on a surgeon’s birthday exhibited higher mortality compared with patients who underwent surgery on other days. Mortality went up 23% (from 5.6% to 6.9%)!
✅ What it means: Even surgeons, who are sometimes compared to the closest thing to gods on earth, are humans. They get distracted on their birthdays, they want to hurry up and celebrate with loved ones, or they keep checking their phone to read celebratory messages from their loved ones. It is reasonable to assume that surgeons can get distracted by other events (e.g., their dating life, a sports game) and that the variability of the outcomes in surgery can be partially explained by these distractions.
The fact that a birthday can lead to a life or death outcome for a patient is an extreme example. It shows the needs for:
Real-time quality monitoring of surgical procedures
Standardization of care in surgical procedures
Root-cause analysis and quality tracking over time
Despite my enthusiasm for the topic, I’ll try to keep it short and focus on two players that aim to use technology to streamline surgery and standardize outcomes.
Founded in 2016, KelaHealth is surgical risk stratification and management software.
👩🏼💻 Team: it was started by a team of MDs, statisticians and engineers at Duke University. MDs who build deep clinical workflow software always have an advantage compared to traditional business founders: they know the processes in and out. They know what solutions will work in real life and can be adopted by providers. But they sometimes lack the business acumen to sell their solutions in a scalable way. The initial CTO and co-founder seems to have left the business a year ago and was replaced by a new CTO. They don’t have anyone on the team with a sales role yet (they are hiring one though).
📊 Product: Their algorithms take in patient data and predict the probability of developing a complication. For each type of risk, they provide a treatment recommendation to optimize outcomes. They claim that the algorithms are trained on millions of procedures:
How did they get access to the data from millions of procedures? Accessing patients records in Europe and in the US is super challenging due to privacy regulation. Patient data need to be deidentified which is time-consuming and expensive. AI companies that want to access patient data need to sign stringent data sharing agreements, and these may take up to two years to be negotiated with hospitals.
The recommendations they make impact care throughout the entire perioperative workflow. They recommend anything from smoking cessation prior to surgery to late discharge to what type of instrument to use during the surgery. These recommendations cater to multiple practitioners (surgeon, nurse…). It isn’t clear how they are integrated into existing workflows, and what has been done to build trust with providers. Providers hate being told by a software how to take care of patients. A lot of them believe that clinical care is an art more than a science, and that they need to be the ones making the final call to customize care to each patient. So I wonder how KelaHealth dealt with these challenges,
💸 Investors: They raised US$12.9m in late 2020: they were the first company backed by Intuitive Surgical, the world leader in robotic surgery, with their newly founded venture arm.
🏥 Go-to-market: it is unclear when they went live with the product. They market several case studies on their website that show they generated significant savings and complications reduction at some of their clients including the elite institution Cedars-Sinai Medical Center. I’ll be keeping an eye on them to see how they use the funds for their recent fundraise to gain traction in the US. In general, as soon as you see that a start-up hires implementation / support people, it means that they are starting to scale sales and that they have enough clients that they need dedicated people to integrate their solutions in the local IT infrastructure of the hospital.
Pipra Health is another pre-surgery risk assessment start-up. They were founded two years ago in Switzerland, and have raised EUR2m from one of the EIT programs. Two main points differentiate them from KelaHealth:
They only focus on the patient's risk of suffering from cognitive disorders after a surgery which means that their product only covers a fraction of the complication risks that come with surgery.
Their risk calculator is based on the existing research in the field. At this stage, it doesn’t seem to rely on machine learning algorithms. So their product must have been easier to develop and didn’t require extensive access to patient records.
That’s a wrap for today! Don’t hesitate to reply to this email with comments, I read and answer all emails :)