Thursday, January 12, 2012

Older surgeons may not be better surgeons, but….READ THE WHOLE PAPER

The internet was abuzz yesterday with headlines like these.

Healthfinder/HealthDay: Surgeons in mid-career have fewest complications
MedPage Today: Best surgeons are not too young or too old
Discovery: Older surgeons may not be better surgeons

The story was tweeted widely.

This is yet another instance where one must read the entire paper to see what the facts are.

What the headlines don’t mention are the following:

Only 28 surgeons were studied. The study is about thyroid surgery only. Age did not matter in the incidence of recurrent laryngeal nerve injury. There was a statistically significant difference in the rate of postoperative hypoparathyroidism depending on the length of experience and age of the surgeon. But the figure below shows that only 5 surgeons above the age of 50 experienced this complication. 

Dotted lines are Confidence Intervals; Ordinate is predicted complication rate.
 The manner in which surgeons were grouped by length of experience was odd. Wouldn’t it be logical to divide them by years such as <5, 5-10, 11-15, 16-20 and >20? The authors divided the surgeons by length of experience this way: <2 years, 8 surgeons; 2-4 years, 7 surgeons; 5-19 years, 6 surgeons; ≥20 years, 7 surgeons.

The authors admit that their study has limitations. Here are some of them. The study is not applicable to other types of surgery. There were few middle-aged surgeons. Despite attempting to adjust for risk, complexity of surgery might not have been accurately defined. [Older surgeons might have been referred harder cases.] Not mentioned was that the number of thyroidectomies for each experience or age group was not stated.

The overall incidence of complications was quite acceptable with recurrent laryngeal nerve palsy occurring in 2.1% of patients and hypoparathyroidism in 2.7%.

A 2006 study published in Annals of Surgery looked at outcomes for 461,000 Medicare patients. They divided surgeons [logically] into groups by age (≤40 years, 41-50 years, 51-60 years, and >60 years). They concluded, “For some complex procedures, surgeons older than 60 years, particularly those with low procedure volumes, have higher operative mortality rates than their younger counterparts. For most procedures, however, surgeon age is not an important predictor of operative risk.”

Bottom line: It’s OK if you are operated on by an older surgeon.


Dr Nikola said...

I'm a young surgeon for a starter. So now with this disclaimer I can get right to the point. What does age can in heaven got to do with complication rate?! The only thing that matters is your volume. The more you operate the better you get. Easy as that. That's for surgical outcome. Then if we look at diagnostic side of our job - with all respect to abilities of young surgeons: nothing compares to experience. dot.

Skeptical Scalpel said...

Dr Nikola,

In general, I agree with you but not everyone gets better with just doing more cases. It's just the same as if I played tennis 8 hours a day for 10 years, I would still never be good enough for the pro tour.

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