A Doctor's Age May Matter With Emergency Surgery
WEDNESDAY, April 25, 2018 -- If you need an emergency operation, you're in safer hands with an older surgeon, new research suggests.
"These findings provide evidence of a learning curve in surgical practice that has a meaningful impact on patients' outcomes," said lead researcher Dr. Yusuke Tsugawa. He's with the UCLA David Geffen School of Medicine's division of general internal medicine and health services research, in Los Angeles.
But the nature of the study does not allow the researchers to say that a doctor's younger age causes more deaths, only that age and outcome seem to be connected.
If, however, age is linked to outcome, then one less death would occur for every 333 patients when comparing surgeons 60 and older with surgeons under 40 -- if quality of care were equal between the two groups, the researchers said.
"Our findings suggest that more oversight and supervision early in a surgeon's post-residency career may be useful to make sure that the quality of care is high, regardless of who performs surgeries," Tsugawa said.
For the study, Tsugawa and his colleagues looked at death rates among more than 892,000 Medicare patients who had one of 20 major emergency surgical procedures at U.S. hospitals between 2011 and 2014.
After taking into account a range of patient, surgeon and hospital characteristics that might have skewed the findings, the researchers compared deaths after surgery according to the surgeon's age and gender.
In all, more than 45,800 surgeons were involved and the overall death rate was 6.4 percent (nearly 57,000 patients).
Tsugawa's team found that patient deaths were slightly lower for older surgeons than for younger surgeons in the same hospital.
The death rate was 6.6 percent for surgeons under 40; 6.5 percent for surgeons 40 to 49; 6.4 percent for surgeons 50 to 59; and 6.3 percent for surgeons 60 and older, the researchers found.
Death rates did not differ between male and female surgeons, Tsugawa said.
Also, death rates weren't affected by the patient's gender or severity of illness, the study found.
For non-emergency elective surgery, no difference in death rates was seen, Tsugawa said.
The report was published online April 25 in the journal BMJ.
Dr. Natalie Coburn is an associate professor of surgery at Sunnybrook Health Sciences Centre in Toronto. She said the factors that go into patient survival after surgery are more complex than the age of the doctor performing the operation.
"A lot of what appears to be a better outcome may not be technical factors but just choosing who one takes to surgery," Coburn said.
In addition, the number of specific operations a surgeon does and the number of those operations a hospital does are important factors that affect outcomes, said Coburn, who coauthored an editorial that accompanied the study.
"There is a lot of complexity that goes into surgical decision-making that are difficult to measure," she said. "So, it's hard to draw conclusions about outcomes for any particular surgeon."
Patients need to quiz their surgeon about how many of a particular procedure he or she does, and how many are done in that particular hospital, Coburn said.
"Patients should know a lot about their surgery and have a list of questions to ask their doctor," she said.
For more on surgery, visit the U.S. National Library of Medicine.
Posted: April 2018