Cystectomy outcomes: Does surgeon's age matter?

Ann Arbor, MI-Surgeon age is not a significant predictor of risk of mortality after cystectomy, according to the results of a recently published study from researchers at the University of Michigan, Ann Arbor (Ann Surg 2006; 244:353-62).

The investigation used a Medicare database to analyze rates of mortality based on surgeon age among patients undergoing eight surgical procedures, including cystectomy. Data were extracted for the years 1998 and 1999 for patients who underwent cystectomy, lung resection, esophagectomy, pancreatectomy, elective repair of abdominal aortic aneurysm, carotid endarterectomy, aortic valve replacement, and coronary artery bypass grafting (CABG).

Surgeons were divided by age into four subgroups: <40 years, 41 to 50 years, 51 to 60 years, and >61 years. The association between surgeon age and patient mortality rates was analyzed using multiple logistic regression techniques adjusting for patient and provider characteristics and using the 41-to 50-year-old bracket as the referent group. Deaths occurring in the hospital or within 30 days of surgery were used in mortality rate calculations.

Among the other surgical procedures, an effect of age on operative mortality was identified only for pancreatectomy, CABG, and carotid endarterectomy, with the rate being significantly higher for the oldest surgeons compared with those ages 41 to 50. However, the rate differences were numerically small, and seemed to be accounted for primarily by surgeons with low procedural volume.

More important factors

"Results from previously published studies indicate the aging process adversely affects the performance of primary care physicians, but the question of whether advancing age has any impact on outcomes of surgeons has not been well studied," said Jennifer F. Waljee, MD, a general surgery resident at the University of Michigan working with John D. Birkmeyer, MD, and colleagues. "Our analyses would indicate that surgeon age should not be a primary factor considered by patients in selecting a surgeon, but, rather, that features such as reputation, operative volume, site of practice, and available credible outcomes data are more important to take into account."

Dr. Waljee also noted that the American College of Surgeons has been developing criteria for credentialing to ensure surgeon competency with certain techniques.

"Although our findings suggest that, for some procedures, surgeon age is associated with operative mortality for lower-volume surgeons, more data are needed to understand how the aging process affects surgeon performance," she said.

Currently, the University of Michigan researchers are considering additional studies on this topic.

Declining eyesight and fine-motor skills, delegation to surgical trainees, and lower familiarity with new techniques and technologies may be postulated as potential reasons why mortality outcomes may be poorer among older surgeons.

"Although we can speculate on the reasons why certain procedures may be affected by surgeon age, such as demand for precision or size of suture, future study is needed to understand why some procedures are affected more than others and the mechanisms that underlie these differences," Dr. Waljee noted.