Dispelling the Darkness: An Analysis of the Black Cloud Phenomenon in Orthopedic Surgery

Background The term “black cloud” is commonly used among surgical residency programs to refer to someone who has a relative tendency to attract a disproportionate number of consults or surgeries while on call. This study aimed to evaluate whether “black clouds” exist in orthopedic surgery and assess other variables that may influence workload on a given call shift. Methods Information from 632 call shifts was retrospectively reviewed from an orthopedic trauma service at a Level I trauma center. Primary outcomes included the number of consults and add-on surgeries scheduled during each 24-hour shift among individual residents and attending physicians. Additionally, days of the week, seasons, weather patterns, holidays, and other superstitious variables were investigated. Results Individual residents or attending physicians were not associated with the number of consults (p = 0.478; p = 0.561) or add-on surgeries/shift (p = 0.436; p = 0.429). However, more consults/shift occurred during the summer (p = 0.001), on weekends (p = <0.001), on sunny days (p = 0.004), and days without rain (p = 0.013) or snow (p = 0.016). Average daily temperature was also positively correlated with both consults/shift (rs = 0.175; p = <0.001) and add-on surgeries/shift (rs = 0.118; p = 0.003). Conclusion The overall volume of consults and add-on surgeries was associated with several weather and calendar-related variables, but not the individual resident or attending surgeon on call in our data set. Thus, it appears more appropriate to consider a “black cloud” in the literal sense rather than a figurative one.