Relation between surgeon age and postoperative outcomes: a population-based cohort study

Abstract

H igh-quality surgical outcomes require sound knowledge, communication skills, clinical judgment and technical proficiency. 1 Aging of the surgical workforce has been well recognized; however, the effect on patient outcomes is unclear. 2,3 The effect of aging, namely cognitive impairment, decline in visual acuity and worsening motor function, may negatively affect surgical ability. 4 However, age-related decline may be offset by the older surgeon's years of clinical acumen, surgical experience and clinical judgement. In addition, because surgeon volume is associated with improved surgical outcomes, 5,6 it is unclear whether surgical volume may offset age-related effects. Thus, surgical volume and age-related effects need to be evaluated concurrently. 7,8 Published evidence about the effect of physician age and experience on surgical outcomes shows mixed results. 9-11 Among Medicare beneficiaries undergoing pancreatectomy, coronary artery bypass grafting and carotid endarterectomy, mortality was higher among those treated by surgeons older than 60 years, especially those with low volumes. 12 This was corroborated in subsequent studies of particular surgical procedures. 13-15 In 2018, an observational study involving patients in the United States who were Medicare beneficiaries reported that patients who were treated by older surgeons had lower rates of mortality than those treated by younger surgeons. 16 However, these data lacked generalizability because the study included only a limited number of nonelective surgical procedures in patients 65 years and older and failed to inform the safety of older physicians performing most surgeries, elective procedures. We aimed to fill these knowledge gaps by assessing the association between surgeon age and outcomes across a broad range of patient age, surgical specialties and common procedures, while adjusting for surgeon volume.

Optimal surgeon and hospital volume thresholds to reduce mortality and length of stay for CABG

“…Provider age has been a surrogate for experience [ 55 – 57 ]. Previous studies have found that surgeon age was negatively related to operative mortality [ 58 , 59 ]. The possible mechanism is that the accumulation of skill and knowledge derived from experience could be associated with better outcomes [ 59 ].…”

Factors affecting the surgeon preference for bolus opioid use to control postoperative pain after bariatric surgery

“…Although a few previous studies investigated obesity surgery and the age of the surgeon, these were mainly concerning the choice of surgery and postoperative complications [9]. In one study by Satkunasivam et al [10], higher surgeon age was associated with lower rate of postoperative complications and mortality, which was explained by the selection of patients with a lower risk of complications. One potential reason for the reduced use of opioids by more senior surgeons in our study may be related with the concerns regarding opioid-related complications.…”

“…Our literature search failed to identify any studies examining the factors that have an impact on the choice of postoperative analgesia management and opioid use among bariatric and metabolic surgeons. Reluctance of more senior surgeons over 55 years of age to use opioids may be related with their more cautious attitudes based on their clinical experience [10].…”

Successful navigation of late career transitions

“…Of note, patients receiving treatment from surgeons who were older than 65 years of age had a 7% lower odds of adverse outcomes. 10 There are very little research data evaluating the relationship between anesthesiologist age and patient outcomes. One landmark paper, however, reported the association between anesthesiologist age and litigation.…”

“…In a recently published population‐based cohort study of over a million surgical patients in Ontario, Canada, increasing surgeon age was found to be associated with decreasing rates of postoperative death, readmission, and complications. Of note, patients receiving treatment from surgeons who were older than 65 years of age had a 7% lower odds of adverse outcomes 10 …”