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Senior Citizen Health & Medicine
Age of Surgeon is Not Important Predictor of Risk
for Patient
Previous studies said older physicians not up on
new treatments, tend to perform poorly
August 24, 2006 When you need complex
cardiovascular or cancer surgery, you have to choose a surgeon and many
senior citizens may turn to an older physician, assuming his experience
may be needed. New research says your right experience matters. But,
older surgeons those over age 60 who do not maintain a high surgical
volume as they age are more likely to have high patient mortality rate
than younger surgeons.
The researchers at the University of Michigan
Health System say patients should be less concerned about the age of
their surgeon and more focused on other factors that really count like
surgical volume.
These findings, published in the September issue of
the Annals of Surgery, reveal that for some complex cardiovascular and
cancer surgical procedures, older surgeons who continued to maintain
higher surgical case loads were found to have comparable outcomes to
peers ages 41 to 50.
The study also dispels the belief that younger,
less experienced surgeons are more likely to have poor surgical
outcomes. Instead, the researchers say young surgeons, ages 40 and
under, had similar patient mortality rates to those of their more
experienced peers for the eight surgical procedures studied.
This studys results should be very encouraging
not only for patients, but also for younger and older surgeons whose
operative skills may previously have been the subject of scrutiny, says
lead author Jennifer F. Waljee, M.D., M.P.H., general surgery resident
in the Department of Surgery at the U-M Medical School.
The bottom line is that for most procedures the
age of the surgeon is not an important predictor of operative risk for a
patient. The effect of surgeon age was largely limited to those surgeons
with lower procedure volumes.
Previous studies that focused on primary care have
suggested an inverse relationship between a surgeons age and his or her
clinical performance. Theyve found that older physicians are less
likely to know about new treatments and medications, and tend to perform
poorly on recertification exams.
Based on these recent studies, Waljee and her
colleagues wondered if some of the common mental and physical affects of
aging might affect older surgeons performance in the operating room, as
well.
Using data from the National Medicare Inpatient
Files, the team reviewed eight major cardiovascular procedures and
cancer surgical resections that were performed from 1998 to 1999 on
patients between the ages 65 to 99.
For the study, surgeons were placed into three age
groups: 40 years and younger, ages 41-50, and 60 years and older.
A total of 460,738 Medicare patients who underwent
one of the eight surgical procedures coronary artery bypass grafting;
elective abdominal aortic aneurysm repair, aortic valve replacement,
carotid endarterectomy, pancreatectomy, esophagectomy, lung resection
and cystectomy were used for this study. These procedures were chosen
because they are some of the more commonly-performed procedures among
Medicare patients, says Waljee.
Patient operative mortality death before
discharge or within 30 days of surgery was reviewed for each patient.
Additionally, factors such as surgeon procedure volume, hospital surgery
volume and the hospitals teaching status were evaluated.
Overall, surgeons over age 60 were found to have
higher patient mortality rates when compared against the rates of
surgeons ages 41-50, for three of the eight procedures: pancreatectomy,
coronary artery bypass grafting, and carotid endarterectomy. Surgeon age
was not related to mortality for elective abdominal aortic aneurysm
repair, aortic valve replacement, exophagectomy, lung resection or
cystectomy.
More surprising to researchers, however, was that
the younger surgeons those under age 40 had comparable mortality to
surgeons between the ages of 41 and 50, for all eight procedures.
We expected to see a significant difference in
patient mortality at the extremes of surgeon age, but instead found very
little variation among younger and older surgeons, says Waljee, a
Robert Wood Johnson Clinical Scholar. Based on these finding, wed
encourage patients not to focus on age when selecting a surgeon.
Instead, other characteristics of the provider and practice setting,
such as operative volume, are likely better predictors of patient
outcome than surgeon age.
Waljee hopes to further explore this topic through
future research to determine if specific mechanisms of aging (physical
and mental stamina, vision and motor skills) affect low-volume surgeons
performance in the OR.
Notes:
Along with Waljee, co-authors from the U-M
Department of Surgerys Michigan Surgical Collaborative for Outcomes
Research and Evaluation (M-SCORE) are Lazar J. Greenfield, M.D.; Justin
B. Dimick, M.D., M.P.H.; and John D. Birkmeyer, M.D.
The study was funded by the U-M Health System.
Reference: Annals of Surgery, September 2006,
Vol. 244.
Original report written by Krista Hopson
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