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August 24, 2006

U-M study: Donít judge a surgeon by his or her age

Low volume surgeons older than 60 had higher mortality rates with certain complex procedures; younger surgeon mortality rates comparable to peers ages 41- 50

ANN ARBOR, MI – 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 the really count – like surgical volume – when choosing a surgeon.

Jennifer F. Waljee, M.D., M.P.H.These findings, published in the September issue of the Annals of Surgery, reveal that for some complex cardiovascular and cancer surgical procedures, surgeons older than 60 with low surgical volumes had higher patient mortality rates than their younger counterparts. However, 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 study’s 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 surgeon’s age and his or her clinical performance. They’ve 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 effects 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 hospital’s 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, we’d 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. 

Along with Waljee, co-authors from the U-M Department of Surgery’s 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.

Written by Krista Hopson 

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