Raj Satkunasivam1, Zachary Klaassen2, Bheeshma Ravi2, Kai-Ho Fok2, Terri Menser2, Bita Kash2, Brian J Miles2, Barbara Bass2, Allan S Detsky2, Christopher J D Wallis2. 1. Department of Urology (Satkunasivam, Miles) and Center for Outcomes Research (Satkunasivam, Menser, Kash, Bass), Houston Methodist Hospital, Houston, Tex.; Division of Urology (Klaassen), Medical College of Georgia - Augusta University, Augusta, Ga.; Division of Orthopedic Surgery (Ravi), Department of Surgery, and Sunnybrook Health Sciences, Centre, and Division of Urology (Fok, Wallis), Department of Surgery, University of Toronto, Toronto, Ont.; Department of Health Policy and Management (Kash), School of Public Health, Texas A&M University, College Station Tex.; Department of Surgery (Menser, Bass), Houston Methodist Hospital, Houston, Tex.; Institute for Health Policy, Management and Evaluation and Department of Medicine (Detsky), University of Toronto; Department of Medicine (Detsky), Mount Sinai Hospital and University Health Network, Toronto, Ont.; Department of Urology (Wallis), Vanderbilt University Medical Center, Nashville, Tenn. raj.satkunasivam@gmail.com. 2. Department of Urology (Satkunasivam, Miles) and Center for Outcomes Research (Satkunasivam, Menser, Kash, Bass), Houston Methodist Hospital, Houston, Tex.; Division of Urology (Klaassen), Medical College of Georgia - Augusta University, Augusta, Ga.; Division of Orthopedic Surgery (Ravi), Department of Surgery, and Sunnybrook Health Sciences, Centre, and Division of Urology (Fok, Wallis), Department of Surgery, University of Toronto, Toronto, Ont.; Department of Health Policy and Management (Kash), School of Public Health, Texas A&M University, College Station Tex.; Department of Surgery (Menser, Bass), Houston Methodist Hospital, Houston, Tex.; Institute for Health Policy, Management and Evaluation and Department of Medicine (Detsky), University of Toronto; Department of Medicine (Detsky), Mount Sinai Hospital and University Health Network, Toronto, Ont.; Department of Urology (Wallis), Vanderbilt University Medical Center, Nashville, Tenn.
Abstract
BACKGROUND: Aging may detrimentally affect cognitive and motor function. However, age is also associated with experience, and how these factors interplay and affect outcomes following surgery is unclear. We sought to evaluate the effect of surgeon age on postoperative outcomes in patients undergoing common surgical procedures. METHODS: We performed a retrospective cohort study of patients undergoing 1 of 25 common surgical procedures in Ontario, Canada, from 2007 to 2015. We evaluated the association between surgeon age and a composite outcome of death, readmission and complications. We used generalized estimating equations for analysis, accounting for relevant patient-, procedure-, surgeon- and hospital-level factors. RESULTS: We found 1 159 676 eligible patients who were treated by 3314 surgeons and ranged in age from 27 to 81 years. Modelled as a continuous variable, a 10-year increase in surgeon age was associated with a 5% relative decreased odds of the composite outcome (adjusted odds ratio [OR] 0.95, 95% confidence interval [CI] 0.92 to 0.98, p = 0.002). Considered dichotomously, patients receiving treatment from surgeons who were older than 65 years of age had a 7% lower odds of adverse outcomes (adjusted OR 0.93, 95% CI 0.88-0.97, p = 0.03; crude absolute difference = 3.1%). INTERPRETATION: We found that increasing surgeon age was associated with decreasing rates of postoperative death, readmission and complications in a nearly linear fashion after accounting for patient-, procedure-, surgeon- and hospital-level factors. Further evaluation of the mechanisms underlying these findings may help to improve patient safety and outcomes, and inform policy about maintenance of certification and retirement age for surgeons.
BACKGROUND: Aging may detrimentally affect cognitive and motor function. However, age is also associated with experience, and how these factors interplay and affect outcomes following surgery is unclear. We sought to evaluate the effect of surgeon age on postoperative outcomes in patients undergoing common surgical procedures. METHODS: We performed a retrospective cohort study of patients undergoing 1 of 25 common surgical procedures in Ontario, Canada, from 2007 to 2015. We evaluated the association between surgeon age and a composite outcome of death, readmission and complications. We used generalized estimating equations for analysis, accounting for relevant patient-, procedure-, surgeon- and hospital-level factors. RESULTS: We found 1 159 676 eligible patients who were treated by 3314 surgeons and ranged in age from 27 to 81 years. Modelled as a continuous variable, a 10-year increase in surgeon age was associated with a 5% relative decreased odds of the composite outcome (adjusted odds ratio [OR] 0.95, 95% confidence interval [CI] 0.92 to 0.98, p = 0.002). Considered dichotomously, patients receiving treatment from surgeons who were older than 65 years of age had a 7% lower odds of adverse outcomes (adjusted OR 0.93, 95% CI 0.88-0.97, p = 0.03; crude absolute difference = 3.1%). INTERPRETATION: We found that increasing surgeon age was associated with decreasing rates of postoperative death, readmission and complications in a nearly linear fashion after accounting for patient-, procedure-, surgeon- and hospital-level factors. Further evaluation of the mechanisms underlying these findings may help to improve patient safety and outcomes, and inform policy about maintenance of certification and retirement age for surgeons.
Authors: Megan Rajagopal; Joseph Boyle; Vishal Patel; Charles Opalak; Dennis J Rivet; John Reavey-Cantwell Journal: World Neurosurg Date: 2021-09-06 Impact factor: 2.104