How To Return To Throwing Intelligently

As healthcare professionals, we tend to rest on our laurels. We become comfortable with certain outcomes if they fall within our expectations. I believe that we fall victim to survivorship bias when it comes to post-surgical outcomes. If you are unfamiliar with the survivorship bias, let me give you an example.

But first, let me ask you a question. What do you think is the return to pitching rate of MLB pitchers who have Tommy John surgery? In other words, how many make it back to pitching in a MLB game? One more question for you: how many innings do you think that those pitchers throw on average after surgery in their career?

Think about your answers for a second before reading further.

Here are the answers: MLB pitchers return to pitching after Tommy John surgery 80-97% of the time(1). That seems like a great statistic, right? However, if we dig a little deeper into the numbers, as Jon Roegele did, we see that the average MLB pitcher who comes back from Tommy John surgery only pitches in 60 games and throws 100 innings (these statistics were from the years 2000-2009) (2). As he pointed out, that is what we expect from a good season for a reliever. That was the average career of MLB pitchers after having Tommy John.

Now to get back to survivorship bias: name a pitcher who has undergone Tommy John surgery. Chances are you named an elite pitcher or Stephen Strasburg (sorry, I couldn’t resist).

You probably did not think of the end of the bullpen pitcher who had Tommy John and never made it back, or the fifth starter who faded into oblivion. We are biased by the success stories of pitchers who underwent surgery, and we forget about the failures.