Surgery might have a decadeslong learning curve, according to a UCLA-led study.
Researchers found that patients treated by older surgeons had lower death rates within 30 days of their procedures than those treated by younger surgeons. Yusuke Tsugawa, an assistant professor of medicine at UCLA, led and published the study last month in the medical journal The BMJ.
Patient mortality rates were 6.6 percent for surgeons younger than 40 years old, 6.5 percent for surgeons aged 40 to 49, 6.4 percent for surgeons 50 to 59 and 6.3 percent for surgeons 60 and older, after accounting for factors that may affect survival, such as patients’ age and type of surgery.
The researchers also looked at surgeons’ gender and found no evidence of a difference in mortality between patients treated by female versus male surgeons. When combining the data on age and gender, the researchers found that female surgeons in their 50s had the lowest patient mortality.
“A lot of patients may perceive that gray-haired, male surgeons might be better than young, female surgeons,” Tsugawa said. “They have specific views about who may be good surgeons, which (had not been) supported by evidence.”
The relationship between a surgeon’s age and patient outcomes had previously been unclear to health researchers, Tsugawa said. Surgical performance might improve over a surgeon’s career because of the accumulated experience from operating on more patients. On the other hand, an older surgeon could have declining dexterity or cognitive functions, he added.
Tsugawa also said younger doctors and surgeons could have better patient outcomes because they are trained in the latest practices and technology. For example, hospital physicians depend on their medical knowledge to determine what antibiotics to prescribe for an infection. However, that medical knowledge changes depending on when they received their education, as guidelines and information regarding antibiotics change over time.
In this study, the researchers examined Medicare patients between 2011 and 2014 who underwent one of 20 major surgeries, such as hip fracture and heart valve procedures. They then linked the operations to surgeons in a database of physicians.
Tsugawa said the researchers limited their study to emergency surgeries to minimize the chance that patients chose their surgeons based on age or gender. Tsugawa added that he thinks in nonemergency situations, older surgeons are more often tasked to handle more sick patients, which often result in poorer outcomes even if the doctors are not providing worse care.
The results of the study suggest that cumulative experience plays a large role in a surgeon’s performance, Tsugawa said. He added that self-selection may play a role, with highly-skilled surgeons more likely to continue performing procedures throughout their career, while lower-skilled surgeons may choose to pursue other work in a hospital as they age.
He also said there is no formal retirement age for doctors in the United States, and surgeons who experience a decline in procedural skills might choose to no longer operate on patients.
“Not many surgeons were practicing at age 80,” he said. “I think they are making their own decisions to retire or stop operating on their patients once they are not at their peak.”
Despite the differences the researchers found, older surgeons were not performing dramatically better than younger surgeons, Tsugawa said. He added he does not recommend that patients choose their surgeons or doctors based on age or gender, and that patients should focus on more important information about doctors, such as how well they communicate.
“The interesting part is that age and gender shouldn’t have any causal impact on patient mortality,” Tsugawa said. “Younger and older surgeons, by definition, shouldn’t have any difference in terms of patient mortality if they are performing surgery in exactly the same way.”
Previous studies have shown there is a variation in how doctors practice medicine, Tsugawa said. For example, female doctors are likely to provide more preventive care or spend more time with their patients than male doctors do, he said.
He added that understanding why female surgeons in their 50s had the lowest patient mortality in this study could tell health policymakers or educators how to improve surgical quality of care.
“Ultimately, I think what we want is for patients to receive the highest quality of care regardless of the surgeons they pick,” Tsugawa said.