BMJ: 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 death rates differ between male and female surgeons.
If
the results are causal, the researchers say that for every 333 of these
patients 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 operative mortality rate (defined as death while in
hospital 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
mortality 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 patient outcomes,
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.”
[Ends]
Age and sex of surgeons and mortality of elderly surgical patients: observational study
https://www.bmj.com/content/361/bmj.k1343
https://www.bmj.com/content/361/bmj.k1343
Editorial: Links between age and sex of surgeons and patient outcomes
https://www.bmj.com/content/ 361/bmj.k1691
https://www.bmj.com/content/