The Aging Surgeon
The Aging Surgeon
Sixty years after Sauerbruch's dismissal, there is overwhelming anecdotal evidence and some published evidence that the aging surgeon remains a problem.
Hartz et al found that mortality rates of surgeons performing coronary artery bypass grafts increased with increasing years of practice. Older surgeons performing carotid endarterectomy had higher mortality rates than younger surgeons in the study of O'Neill et al. Laparoscopic inguinal herniorrhaphy led to higher hernia recurrence rates when performed by older surgeons when compared with younger surgeons. Waljee et al examined the files of 461,000 Medicare patients and reported that older surgeons did have higher operative mortality rates for pancreatectomy, coronary artery bypass grafts, and carotid endarterectomy relative to younger surgeons, but the difference was small and limited to surgeons with low procedure volumes. She concluded that "surgeon age is a relatively weak predictor of operative mortality in aggregate and certainly much worse for discriminating performance among individual surgeons."
Those few individual surgeons, however, are the problem, a problem encountered by nearly every chief of surgery, vice-president of medical affairs, and hospital president sometime during his or her tenure. One of us (M.R.K.) sought anecdotes from members of the Society of Surgical Chairs and was told, "he fell asleep taking down the internal mammary artery," "had to organize an 'intervention' led by other senior/retired surgeons," "operating room nurses were in tears in my office, saying 'you must stop him.'"
Compounding the problem, a lack of self-awareness is common, though not exclusive to, this small group of problematic senior surgeons. A survey of 995 surgeons by Greenfield's group found that most senior surgeons reported no changes in perceived cognitive abilities with age. A review of this subject in 2006 concluded, "the preponderance of evidence suggests that physicians have a limited ability to accurately self-assess."
How large a potential issue is this? The American College of Surgeons lists 5763 senior fellows older than 70 years, a category defined as "actively practicing but no longer required to pay dues." Given that only 25% to 30% of surgeons are fellows at all, the total number of septuagenarian surgeons practicing approaches 20,000.
Is the Aging Surgeon Still a Problem?
Sixty years after Sauerbruch's dismissal, there is overwhelming anecdotal evidence and some published evidence that the aging surgeon remains a problem.
Hartz et al found that mortality rates of surgeons performing coronary artery bypass grafts increased with increasing years of practice. Older surgeons performing carotid endarterectomy had higher mortality rates than younger surgeons in the study of O'Neill et al. Laparoscopic inguinal herniorrhaphy led to higher hernia recurrence rates when performed by older surgeons when compared with younger surgeons. Waljee et al examined the files of 461,000 Medicare patients and reported that older surgeons did have higher operative mortality rates for pancreatectomy, coronary artery bypass grafts, and carotid endarterectomy relative to younger surgeons, but the difference was small and limited to surgeons with low procedure volumes. She concluded that "surgeon age is a relatively weak predictor of operative mortality in aggregate and certainly much worse for discriminating performance among individual surgeons."
Those few individual surgeons, however, are the problem, a problem encountered by nearly every chief of surgery, vice-president of medical affairs, and hospital president sometime during his or her tenure. One of us (M.R.K.) sought anecdotes from members of the Society of Surgical Chairs and was told, "he fell asleep taking down the internal mammary artery," "had to organize an 'intervention' led by other senior/retired surgeons," "operating room nurses were in tears in my office, saying 'you must stop him.'"
Compounding the problem, a lack of self-awareness is common, though not exclusive to, this small group of problematic senior surgeons. A survey of 995 surgeons by Greenfield's group found that most senior surgeons reported no changes in perceived cognitive abilities with age. A review of this subject in 2006 concluded, "the preponderance of evidence suggests that physicians have a limited ability to accurately self-assess."
How large a potential issue is this? The American College of Surgeons lists 5763 senior fellows older than 70 years, a category defined as "actively practicing but no longer required to pay dues." Given that only 25% to 30% of surgeons are fellows at all, the total number of septuagenarian surgeons practicing approaches 20,000.
