Older surgeons have lower patient mortality rates

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Researchers from University of California – Los Angeles, Harvard TH Chan School of Public Health, Brigham and Women’s Hospital, the VA Healthcare System Boston, Harvard Medical School and Massachusetts General Hospital found surgeries performed by older surgeons – age 50 and up – have lower patient mortality rates than those performed by younger surgeons, and that patient mortality rates do not differ significantly based on whether the surgeon is male or female.

Broken down by age group and adjusting for various patient characteristics, mortality rates were 6.6% for surgeons aged 40 and younger, 6.5% for those 40 to 49 years old, 6.4% for surgeons aged 50 to 59 years, and 6.3% for surgeons age 60 and older. The study also showed that when comparing men and women surgeons across those four age groups, female surgeons in their 50s had the lowest patient mortality rate.

There has been limited research about how a surgeon’s age, gender and other characteristics are correlated with patient outcomes. The researchers set out to understand whether surgeons’ skills improve with experience, and whether a loss of dexterity or less familiarity with new technologies contributed to poorer surgical outcomes for older doctors. There also has been concern that tighter restrictions on training hours during the residencies of younger surgeons might negatively affect their skills later on.

The researchers examined the medical records of 892,187 Medicare patients aged 65 to 99 who had one of 20 common types of emergency surgery between 2011 and 2014. The records incorporated procedures performed by 45,826 surgeons. The study focused on surgeries for which patients are less likely to select their surgeons, and surgeons are less likely to select their patients.

Among the potential limitations to the study are that the findings may not be applicable to long-term mortality and complication rates, and that the analysis was limited to Medicare patients and may not apply to non-Medicare patients, physicians in other specialties and outpatient care.

The findings suggest a need for more oversight and supervision of surgeons in their early post-residency careers, although the researchers write that further research is warranted.

Objective: To investigate whether patients’ mortality differs according to the age and sex of surgeons.
Design: Observational study.
Setting: US acute care hospitals.
Participants: 100% of Medicare fee-for-service beneficiaries aged 65-99 years who underwent one of 20 major non-elective surgeries between 2011 and 2014.
Main outcome measure: Operative mortality rate of patients, defined as death during hospital admission or within 30 days of the operative procedure, after adjustment for patients’ and surgeons’ characteristics and indicator variables for hospitals.
Results: 892 187 patients who were treated by 45 826 surgeons were included. Patients’ mortality was lower for older surgeons than for younger surgeons: the adjusted operative mortality rates were 6.6% (95% confidence interval 6.5% to 6.7%), 6.5% (6.4% to 6.6%), 6.4% (6.3% to 6.5%), and 6.3% (6.2% to 6.5%) for surgeons aged under 40 years, 40-49 years, 50-59 years, and 60 years or over, respectively (P for trend=0.001). There was no evidence that adjusted operative mortality differed between patients treated by female versus male surgeons (adjusted mortality 6.3% for female surgeons versus 6.5% for male surgeons; adjusted odds ratio 0.97, 95% confidence interval 0.93 to 1.01). 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 50s had the lowest operative mortality.
Conclusion: Using national data on Medicare beneficiaries in the US, this study found that patients treated by older surgeons had lower mortality than patients treated by younger surgeons. There was no evidence that operative mortality differed between male and female surgeons.

Yusuke Tsugawa, Anupam B Jena, E John Orav, Daniel M Blumenthal, Thomas C Tsai, Winta T Mehtsun, Ashish K Jha

University of California – Los Angeles material
BMJ abstract

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