The internet was abuzz earlier this year with headlines such as “Surgeons in Mid-Career Have Fewest Complications,” “Best Surgeons Are Not Too Young or Too Old” and “Older Surgeons May Not Be Better Surgeons.” Respected tweeters such as @CUsafepatient, @hhask and others mentioned the story.
I have blogged before that sometimes the abstract is not as revealing as the paper. This is yet another instance where one must read the entire paper to see what the facts are.
What the headlines didn’t mention were the following:
There were only 28 surgeons studied. The study was 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.
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. Skeptical Scalpel is a recently retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last two years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog has had more than 325,000 page views, and he has over 4100 followers on Twitter.