Age and sex of surgeons and mortality of older surgical patients: observational study

Abstract

ObjectiveTo investigate whether patients’ mortality differs according to the age and sex of surgeons.DesignObservational study.SettingUS acute care hospitals.Participants100% of Medicare fee-for-service beneficiaries aged 65-99 years who underwent one of 20 major non-elective surgeries between 2011 and 2014.Main outcome measureOperative mortality rate of patients, defined as death during hospital admission or within 30 days of the operative procedure, after adjustment for patients’ and surgeons’ characteristics and indicator variables for hospitals.Results892 187 patients who were treated by 45 826 surgeons were included. Patients’ mortality was lower for older surgeons than for younger surgeons: the adjusted operative mortality rates were 6.6% (95% confidence interval 6.5% to 6.7%), 6.5% (6.4% to 6.6%), 6.4% (6.3% to 6.5%), and 6.3% (6.2% to 6.5%) for surgeons aged under 40 years, 40-49 years, 50-59 years, and 60 years or over, respectively (P for trend=0.001). There was no evidence that adjusted operative mortality differed between patients treated by female versus male surgeons (adjusted mortality 6.3% for female surgeons versus 6.5% for male surgeons; adjusted odds ratio 0.97, 95% confidence interval 0.93 to 1.01). After stratification by sex of surgeon, patients’ mortality declined with age of surgeon for both male and female surgeons (except for female surgeons aged 60 or older); female surgeons in their 50s had the lowest operative mortality.ConclusionUsing national data on Medicare beneficiaries in the US, this study found that patients treated by older surgeons had lower mortality than patients treated by younger surgeons. There was no evidence that operative mortality differed between male and female surgeons.

Relation between surgeon age and postoperative outcomes: a population-based cohort study

“…Our work is consistent with the findings of previous studies that showed better performance by older surgeons, 16 but we studied both elective and emergent operative procedures over a much wider patient age range than previously studied. Furthermore, we have shown consistency in results by using additional indicators of surgical outcomes beyond mortality alone (i.e., readmission and complications).…”

Links between age and sex of surgeons and patients’ outcomes

“…These findings conflict with previous studies of hospital physicians in the US and surgeons in Canada, both of which showed superior adjusted outcomes among patients treated by female clinicians 25. Taken together, however, these studies are important 125. In 2018 discrimination based on age, race, gender, and sexual orientation persists, albeit in more insidious forms—subtle innuendos, lack of respect, patients and staff assuming women are not surgeons or surgical decision makers, referral biases, and undermining “locker room talk”.…”

“…Tsugawa and colleagues found no association between surgeons’ sex and patients’ outcomes, although patients treated by female surgeons aged 50-59 had the lowest overall mortality 1. These findings conflict with previous studies of hospital physicians in the US and surgeons in Canada, both of which showed superior adjusted outcomes among patients treated by female clinicians 25.…”

“…In the linked paper (doi:10.1136/bmj.k1343), Tsugawa and colleagues examine the relation between the age and sex of surgeons and perioperative mortality among older US patients undergoing emergency surgery. In this Medicare (federally funded) population, mortality declined with increasing age of surgeon, but the authors found no independent association with surgeons’ sex 1. We applaud their efforts to examine these complex matters.…”

“…Importantly, Tsugawa and colleagues show clear variation in surgical outcomes, identifying opportunities to improve care 1. Benchmarking of adequately risk adjusted outcomes, accounting for all patients under a surgeon’s care and not just those managed operatively, are crucial to understanding when, and eventually how, a clinician exceeds or fails to meet expected outcomes.…”