Fewer Deaths of Patients with Older Surgeons in ED

Researchers at the University of California, Los Angeles (UCLA; USA), Brigham and Women’s Hospital (BWH; Boston, MA, USA), and other institutions conducted an observational study that reviewed the medical records of 892,187 Medicare patients (65 to 99 years of age) who underwent one of 20 common types of emergency surgery by 45,826 surgeons between 2011 and 2014. The researchers then compared operative mortality rates of patients, adjusting for both patients’ and surgeons’ characteristics, and indicator variables for hospitals.

The results revealed that patients’ mortality was lower for older surgeons than for younger surgeons. After adjustment, operative mortality rates were 6.6% for surgeons aged under 40 years, 6.5% for surgeons 40-49 years of age, 6.4% for those 50-59 years of age, and 6.3% for surgeons 60 years or over. After stratification by sex of surgeon, patients’ mortality declined with age of surgeon for both male and female surgeons (except for female surgeons aged 60 or older); female surgeons in their 50’s had the lowest operative mortality. The study was published on April 25, 2018, in BMJ.

“These findings are different from our previous analyses of general internists, which showed that female internists and younger internists had lower patient mortality, which may shed light on the relative importance of knowledge versus procedural skills in medical versus surgical fields,” concluded lead author Yusuke Tsugawa, MD, of UCLA, and colleagues. “Taken together, these findings provide evidence of a long ‘learning curve’ in surgical practice that has a potentially meaningful effect on patients’ outcomes, as well as that male and female surgeons generally deliver care of equivalent quality.”

According to the researchers, several mechanisms may explain the observed association between surgeons’ age and patients’ mortality. First, the accumulation of skills and knowledge from experience may lead to better surgical performance. Second, duty hour regulations could have long-term effect on the performance of younger surgeons. And last, older surgeons who continue to perform procedures throughout their career may be those who are highly skilled, whereas lower skilled surgeons may decide to refrain from procedures and focus on administrative work, research, or teaching as they age.

Related Links:
University of California, Los Angeles
Brigham and Women’s Hospital