Like those nice posts of Kidney Notes called Hilarious Journal Articles I have read in the September issue of Annals of Surgery an article wich concludes the following:
For some complex procedures, surgeons older than 60 years, particularly those with low procedure volumes, have higher operative mortality rates than their younger counterparts. For most procedures, however, surgeon age is not an important predictor of operative risk.
In this study, it was used the national Medicare files examining operative mortality in 461,000 procedures. There were three groups of surgeons age 40 years and less, 41 to 50 years, 51 to 60 years, and 61 years and more.
The complex procedures were: esophagectomy, cystectomy, lung resection, aortic valve replacement and aortic aneurysm repair.
Less experienced surgeons (those of 40 years and less) had comparable mortality rates to surgeons aged 41 to 50 years for all procedures. So, why everyone call them unexperienced?
I should add this: as an older surgeon, with a track record, I was (I think) less concerned about the effect of the occasional riskly patient on my overall record. It might well be, apropos the above comments, that a surgeon just starting out would prefer to be more selective. For good reason, unfortunately.
I’m not surprised to see mortality relate to numbers of cases; but the older/younger aspect would be hard to explain — after all, what good is a study if we can’t learn from it? So the question needs to be separated on the basis of quantity, and re-compared. Also, the older I got, the more respect I had among some referring physicians: they sent me cases that were more complex — people with more concommitant medical conditions, knowing that I’d operate carefully and rapidly and give very attentive postop care. So, if that’s a general truism, it might be that older surgeons have a higher mix of such patients. On the other hand, there are undoubtedly docs and patients who prefer younger surgeons. Data such as these need very careful analysis in order to draw conclusion.
Dr. Savatta:
Exactly, it’s a shame that Statistics and Epidemiology rather than being useful things to make a better world and living it’s going to stop performing difficult operations by nice and kind surgeons.
What is going on?
Thanks for your kind comment
I havent read the entire piece and I am a younger surgeon (under 40), but I am not a big fan of operative mortality.
When you are talking about surgeries such as a radical cystectomy, this is a big operation. More important to a surgeons mortality is who he chooses to operate on.
I have performed 6 of these operations in patients older than 90. One has died at home within a month not due to technical problems. He was doing well and then had something happen to him, probably a sudden heart attack.
By doing these high risk surgeries that most surgeons would not do themselves, I will likely have a higher mortality figure. Data that is kept like this has led heart surgeons to try to avoid the highest of risk patients and I am worried will force people like me to do the same.