Surgeon Age and Operative Mortality in the United States
Jennifer F. Waljee, M.D., M.P.H.*, Lazar J. Greenfield, M.D., Justin B. Dimick, M.D., M.P.H.*, John D. Birkmeyer, M.D.*
University of Michigan, Ann Arbor, MI
Although recent studies suggest that physician age is related to clinical performance in other fields, relationships between surgeon age and operative mortality have not been examined systematically.
Using national Medicare claims and provider files, we identified 461,000 patients undergoing one of eight cardiovascular or cancer procedures between 1998 and 1999. We used multiple logistic regression to assess relationships between surgeon age and operative mortality (in-hospital or within 30 days), adjusting for patient characteristics, hospital factors, and surgeon procedure volume.
Although older surgeons had slightly lower procedure volumes than younger surgeons for most procedures, there were few clinically significant differences in patient characteristics by surgeon age. Surgeon age was not related to operative mortality for esophagectomy, cystectomy, lung resection, aortic valve replacement, or aortic aneurysm repair. Surgeons over 60 years had significantly higher mortality rates with pancreatectomy (adjusted odds ratio 1.67, 95% CI 1.12-2.49), coronary artery bypass grafting (OR 1.17, 95% CI 1.05 - 1.29), and carotid endarterectomy (OR 1.21, 95% CI 1.04 - 1.40), compared with surgeons aged 41-50 years. Relatively inexperienced surgeons (< 40 years of age) had comparable mortality rates to surgeons aged 41-50 years.
Surgeon age was not a significant risk factor for mortality for most of the high risk procedures in this study. Although older surgeons had higher mortality rates for some procedures, surgeon age is a less important predictor of operative mortality with these procedures than other patient and provider characteristics, including patient age, acuity, and provider volume.
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