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Older surgeons lose more patients than younger colleagues

BMJ 2000; 321 doi: (Published 11 November 2000) Cite this as: BMJ 2000;321:1178
  1. Scott Gottlieb
  1. New York

    Surgeons who have been doing carotid endarterectomies for more than 20 years are more likely than less experienced surgeons to have their patients die, research suggests. Dr Liam O'Neill of Cornell University in New York and colleagues believe their findings probably extend to other operations as well (Neurology 2000;55:1263-9).

    Dr O'Neill and colleagues studied information on nearly 13 000 endarterectomies carried out by 532 surgeons over two years in Pennsylvania. The researchers found that surgeons who did the operation once a year or less frequently were three times more likely to have their patients die. But as a group, the oldest surgeons had the worst record in performing carotid endarterectomies, regardless of the number of procedures they performed. Surgeons performing carotid endarterectomies who got their practice licences 20 or more years ago had the highest mortality among their patients—about 1 in 100. “Time in surgical practice was more important than surgical volume as a predictor of patient outcome,” Dr O'Neill said.

    Doctors who had been practising the longest may not be keeping up with latest techniques and improvements, the study's authors said. When the data were examined by surgical specialty, patients whose procedures were performed by neurosurgeons were the least likely to die as a result of the procedure. During endarterectomy, the surgeon removes plaques from the carotid artery and then sews a graft into the wall of the artery. When the carotid artery undergoes significant stenosis, the risk of stroke is increased. The procedure itself is delicate and can trigger a stroke if complications occur.

    One of the researchers, Dr Arthur Hartz of the University of Iowa, said that a previous and similar study that he took part in—looking at doctors who performed heart bypass operations—found results that were also similar to the current study of endarterectomies.

    “So our findings and that of Dr Hartz's other study certainly raise some interesting questions about acceptable surgical volume thresholds and other characteristics that warrant further investigation,” Dr O'Neill said.

    Other studies have consistently shown that hospitals and clinics that have a high volume in certain operations have a better success rate, but this is believed to be the first study to examine specifically the role that the surgeon's age has in predicting outcome.

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