Intended for healthcare professionals


Links between age and sex of surgeons and patients’ outcomes

BMJ 2018; 361 doi: (Published 25 April 2018) Cite this as: BMJ 2018;361:k1691
  1. Natalie Coburn, associate professor of surgery1,
  2. Christopher J D Wallis, urology resident2,
  3. Nancy Baxter, professor of surgery3
  1. 1Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, M4N 3M5, Canada
  2. 2Division of Urology, Sunnybrook Health Sciences Centre, Toronto, ON, M4N 3M5, Canada
  3. 3Division of General Surgery, St. Michaels Hospital, Toronto, ON, M5B 1W8, Canada
  1. Correspondence to: N Coburn natalie.coburn{at}

Unravelling these complex associations will benefit both patients and surgeons

Predictors of surgical outcomes are of interest to patients, referring clinicians, healthcare organisations, and surgeons themselves. In the linked paper (doi:10.1136/bmj.k1343), Tsugawa and colleagues examine the relation between the age and sex of surgeons and perioperative mortality among older US patients undergoing emergency surgery. In this Medicare (federally funded) population, mortality declined with increasing age of surgeon, but the authors found no independent association with surgeons’ sex.1 We applaud their efforts to examine these complex matters. As often happens with observational research, this study raises more questions than it answers.

Previously, Tsugawa found worse outcomes among patients treated by internists with a hospital based practice, as the physicians aged, attributing this to changes in practice since their training and possibly poor adherence to guidelines.2 Conversely, the new study finds that outcomes for emergency surgery improve with age of surgeon, the authors suggesting improved surgical skills with extra years in practice.1

Although technical proficiency affects surgical …

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