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

BMJ 2018; 361 doi: (Published 25 April 2018) Cite this as: BMJ 2018;361:k1343
  1. Yusuke Tsugawa, assistant professor1,
  2. Anupam B Jena, Ruth L Newhouse associate professor2 3 4,
  3. E John Orav, associate professor5 6,
  4. Daniel M Blumenthal, cardiology fellow7,
  5. Thomas C Tsai, surgery resident8 9,
  6. Winta T Mehtsun, surgical resident10,
  7. Ashish K Jha, K T Li professor of international health5 9 11
  1. 1Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
  2. 2Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
  3. 3Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
  4. 4National Bureau of Economic Research, Cambridge, MA, USA
  5. 5Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA, USA
  6. 6Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
  7. 7Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
  8. 8Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA
  9. 9Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
  10. 10Division of Surgery, Massachusetts General Hospital, Boston, MA, USA
  11. 11The VA Healthcare System, Boston, MA 02138, USA
  1. Correspondence to: Y Tsugawa ytsugawa{at}
  • Accepted 7 March 2018


Objective To investigate whether patients’ mortality differs according to the age and sex of surgeons.

Design Observational study.

Setting US acute care hospitals.

Participants 100% 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 measure Operative 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.

Results 892 187 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.

Conclusion Using 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.


  • Contributors: All authors contributed to the design and conduct of the study, data collection and management, and analysis and interpretation of the data; and preparation, review, or approval of the manuscript. YT is the guarantor.

  • Funding: ABJ was supported by the Office of the Director, National Institutes of Health (NIH early independence award, grant 1DP5OD017897). Study sponsors were not involved in study design, data interpretation, writing, or the decision to submit the article for publication.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at (available on request from the corresponding author) and declare: no support from any organization for the submitted work, other than that detailed above; ABJ has received consulting fees unrelated to this work from Pfizer, Hill Rom Services, Bristol Myers Squibb, Novartis Pharmaceuticals, Vertex Pharmaceuticals, and Precision Health Economics, a company providing consulting services to the life sciences industry;no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: The study was approved by the institutional review board at Harvard Medical School.

  • Data sharing: No additional data available.

  • Transparency statement: The corresponding author affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

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