Emergency treatment by older surgeons linked to slightly lower death rates

April 26, 2018, British Medical Journal

Patients undergoing emergency surgery who are treated by older surgeons (aged 60 or over) have slightly lower death rates in the first few weeks after their operation than patients treated by younger surgeons (aged less than 40) within the same hospital, finds US study published by The BMJ today.

There was no evidence that differ between male and female surgeons.

If the results are causal, the researchers say that for every 333 of these who undergo surgery in the US, one fewer death would occur if quality of care was the same between younger and older surgeons.

Despite strong interest in improving the quality of surgical care, the relationship between surgical characteristics - especially age and sex of surgeons - and patient outcomes is not well understood.

So a research team led by Yusuke Tsugawa at UCLA in California, set out to investigate whether patient mortality differs based on age and sex of surgeons.

They analysed the rate (defined as death while in or within 30 days of surgery) of Medicare patients aged 65-99 years who underwent one of 20 major emergency surgical procedures at US acute care hospitals between 2011 and 2014.

After adjusting for a range of patient, surgeon and hospital characteristics that could have affected the results, they compared operative mortality according to surgeon age and sex.

A total of 892,187 patients were treated by 45,826 surgeons with an overall operative mortality rate of 6.4% (56,803).

The researchers found that patient mortality was slightly lower for older surgeons than for younger surgeons within the same hospital (6.6% for surgeons aged less than 40, 6.5% for surgeons aged 40-49, 6.4% for surgeons aged 50-59, and 6.3% for surgeons aged 60 or over), but did not differ meaningfully between male and female surgeons.

When they analysed the data by both surgeon age and sex, patient mortality declined with surgeon age for both male and female surgeons, with female surgeons in their 50s showing the lowest operative mortality across all groups.

Operative mortality did not differ between male and female surgeons by patient illness severity or for individual procedures. And there was no evidence that mortality differed by surgeon age or sex for non-emergency (elective) procedures.

Previously, the researchers found worse outcomes among patients treated by older hospital physicians, which they attributed to practice changes since training, and possibly poor adherence to guidelines. In contrast, these new findings suggest improved surgical skills with extra years in practice.

This is an observational study, so no firm conclusions can be drawn about cause and effect, and the findings may not be generalisable to other outcomes, such as patient experience or complication rates, they explain. Nevertheless, the study was large, and was able to account for a wide range of potentially influential factors.

As such, they conclude: "Our finding that younger surgeons have higher suggests that more oversight and supervision early in a surgeon's career may be useful and at least warrants further investigation. Equivalent outcomes between male and female surgeons suggest that patients undergoing surgery receive high-quality care irrespective of surgeon sex."

In a linked editorial, Natalie Coburn and colleagues based in Toronto say the researchers "demonstrate clear variation in , identifying opportunities to improve care."

However, they warn that even objective measures are insufficient to address systemic bias. "We must learn to recognise and reduce the implicit biases that each of us inherently holds," they write. "Surgical care will improve faster when we embrace and foster teamwork, communication and diversity within our field."

Explore further: Study finds small differences in patient outcomes between male and female surgeons

More information: Age and sex of surgeons and mortality of elderly surgical patients: observational study, BMJ (2018). www.bmj.com/content/361/bmj.k1343

Editorial: Links between age and sex of surgeons and patient outcomes, BMJ (2018). www.bmj.com/content/361/bmj.k1691

Related Stories

Study finds small differences in patient outcomes between male and female surgeons

October 10, 2017
Patients treated by female surgeons have slightly lower death rates in the first few weeks after their operation than patients treated by male surgeons, finds a study from Canada published by The BMJ today.

Surgery practice patterns differ by location of residency

January 12, 2018
(HealthDay)—Nonuniversity-based residency (NUBR)-trained surgeons and university-based residency (UBR)-trained surgeons have distinct practice patterns, according to a study published online Jan. 10 in JAMA Surgery.

Post-op complications low for orbital floor fracture repair

October 29, 2017
(HealthDay)—For patients undergoing orbital floor fracture repair, total operative time and postoperative complications are similar for cases performed by plastic surgeons versus ear, nose, and throat (ENT) surgeons, according ...

Surgeon case experience impacts peds cholecystectomy morbidity

January 30, 2018
(HealthDay)—High-volume general surgeons have lower morbidity rates than low-volume pediatric surgeons for laparoscopic cholecystectomy in pediatric patients, independent of pediatric volume, according to a study published ...

Study finds flatfoot reconstruction effective for older patients

March 12, 2018
When someone develops adult-acquired flatfoot deformity (AAFD), they are offered either a reconstruction or foot fusion depending on the severity of the flatfoot and their age. Typically reconstructions are performed in younger ...

Surgeon volume impacts parathyroidectomy outcomes

April 22, 2017
(HealthDay)—Patients undergoing parathyroidectomy by high-volume surgeons have a lower rate of vocal cord paralysis compared to patients of low-volume surgeons, according to a study published online April 20 in JAMA Otolaryngology-Head ...

Recommended for you

Surgical adhesions can be treated, prevented in mice

November 28, 2018
A cellular culprit—as well as a possible treatment—for a common, sometimes life-threating post-surgical complication has been identified by researchers at the Stanford University School of Medicine.

Cost and weight-loss potential matter most to bariatric surgery patients

November 28, 2018
A JAMA Surgery study found that patients are likely to base their weight loss surgery choice on expected out-of-pocket costs, and how much weight they can lose—not risk of complications or recovery time.

Treating spinal pain with replacement discs made of 'engineered living tissue' moves closer to reality

November 21, 2018
For the first time, bioengineered spinal discs were successfully implanted and provided long-term function in the largest animal model ever evaluated for tissue-engineered disc replacement. A new Penn Medicine study published ...

Screening for colorectal cancer spares male patients from intense treatments

November 21, 2018
While screening for colorectal cancer does not reduce mortality, it does reduce the need for chemotherapy and emergency surgeries among male patients, according to a recent Finnish study.

Rapid response inpatient education boosts use of needed blood-thinning drugs

November 16, 2018
A new study designed to reach hospitalized patients at risk shows that a "real-time" educational conversation, video or leaflet can lower the missed dose rates of drugs that can prevent potentially lethal blood clots in their ...

Race plays role in regaining weight after gastric bypass surgery

November 15, 2018
African Americans and Hispanic Americans who have undergone Roux-en-Y gastric bypass (RYGB) are at greater risk to regain weight as compared to Caucasians. To date, no study has addressed the effect of race on weight regain ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.