FINDINGS
Researchers from UCLA and several other institutions 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 percent for surgeons aged 40 and younger, 6.5 percent for those 40 to 49 years old, 6.4 percent for surgeons aged 50 to 59 years, and 6.3 percent 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.
BACKGROUND
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.
METHOD
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.
IMPACT
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.
AUTHORS
The study’s lead author is Dr. Yusuke Tsugawa of UCLA, and the senior author is Dr. Ashish Jha of Harvard T.H. Chan School of Public Health, Brigham and Women’s Hospital and the VA Healthcare System Boston. Other authors are Dr. Anupam Jena of Harvard Medical School, Massachusetts General Hospital and the National Bureau of Economic Research; E. John Orav and Dr. Thomas Tsai of Brigham and Women’s Hospital and Harvard Medical School; and Dr. Daniel Blumenthal and Dr. Winta Mehtsun of Massachusetts General Hospital and Harvard Medical School.
JOURNAL
in the British Medical Journal.
