|Never mind the patient, how old is the surgeon?|
|Thursday, 01 July 2010|
Ho J-D, Kuo N-W, Tsai C-Y et al. Surgeon age and operative outcomes for primary rhegmatogenous detachment: a 3-year nationwide population-based study. Eye; February 2010: 290-96.
In a nutshell
The purpose of this report, from Taipei Medical University Hospital, Taiwan, is to study the association of surgeon age with operative outcomes for primary rhegmatogenous retinal detachment (RRD).
The records of 7427 patients who underwent surgery for RRD were analysed. Surgical success was determined by the readmission rate within 180 days of the original surgery. Reattendances for contralateral RRD (giving rise to false ‘failures’) would be relatively rare within the 180-day period.
Three age groups were defined: ?40, 41-50, and ?51 (Groups one, two, and three, respectively). It was noticed during data collection that the style of surgery depended to some extent on surgeon age: group one favouring pars plana vitrectomy and group three scleral buckling, but there were numerous other possible factors for age-related variation in success such as increasing sub-specialisation, recent improvements in instrumentation and technology – possibly not available in smaller or remote hospitals, and delegation of cases to trainees by older trainers.
Although in absolute terms, younger surgeons had lower readmission rates, the conclusion was that surgeon age is a relatively weak predictor for the outcomes of primary RRD surgery.
When considering how surgeon age might relate to surgical skill and success, one might intuitively think that there should first be a period of increasing success with acquisition of new skills and increasing experience, then a plateau of middle-age, its altitude related to the individual surgeon, followed by a decline in skill, dexterity, and possibly visual function towards the end of the surgeon’s career. This pattern is, in fact, supported by only 3% of all the studies in a literature review of the association of doctor age with quality of care. The most consistent pattern, sadly, is of decreasing performance in most areas with increasing years in practice, reflected in 73% of studies. This study is therefore particularly reassuring for retinal surgeons, with the conclusion that for RRD surgery, surgeon age should not be a factor in one’s choice of surgeon.
A significant strength of this study is that use is made of a population-based sample involving large numbers of patients, surgeons, and hospitals. Patients who had surgery in one hospital and re-attended at another would very likely be fully included.