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Surgeon Age and Operative Mortality in the United States

Waljee, Jennifer F. MD, MPH; Greenfield, Lazar J. MD; Dimick, Justin B. MD, MPH; Birkmeyer, John D. MD

doi: 10.1097/01.sla.0000234803.11991.6d
Original Articles

Objectives: Although recent studies suggest that physician age is inversely related to clinical performance in primary care, relationships between surgeon age and patient outcomes have not been examined systematically.

Methods: Using national Medicare files, we examined operative mortality in approximately 461,000 patients undergoing 1 of 8 procedures between 1998 and 1999. We used multiple logistic regression to assess relationships between surgeon age (≤40 years, 41–50 years, 51–60 years, and >60 years) and operative mortality (in-hospital or within 30 days), adjusting for patient characteristics, surgeon procedure volume, and hospital attributes.

Results: Although older surgeons had slightly lower procedure volumes than younger surgeons for some procedures, there were few clinically important differences in patient characteristics by surgeon age. Compared with surgeons aged 41 to 50 years, surgeons over 60 years had higher mortality rates with pancreatectomy (adjusted odds ratio [OR], 1.67; 95% confidence interval [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). The effect of surgeon age was largely restricted to those surgeons with low procedure volumes and was unrelated to mortality for esophagectomy, cystectomy, lung resection, aortic valve replacement, or aortic aneurysm repair. Less experienced surgeons (≤40 years of age) had comparable mortality rates to surgeons aged 41 to 50 years for all procedures.

Conclusions: 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.

In this study, we assess the relationship between surgeon age and operative mortality among Medicare patients in the United States undergoing 1 of 8 complex surgical procedures between 1998 and 1999. For 5 of the 8 procedures, surgeon age did not predict operative mortality. Although surgeons over 60 years of age did have higher mortality rates with coronary artery bypass grafting, carotid endarterectomy, and pancreatectomy, this age effect was restricted primarily to low-volume surgeons.

From the University of Michigan, MA.

Reprints: Jennifer Filip Waljee, MD, MPH, University of Michigan, MI. E-mail: filip@med.umich.edu.

© 2006 Lippincott Williams & Wilkins, Inc.