A recent study by Boston University has provided some really interesting nuggets. It highlights the increasingly delicate balance between the age of surgeons, patient expectations, and satisfaction with spinal surgery. Younger and middle-aged surgeons are more filled with confidence and more in touch with patient expectations. By comparison, their older peers do a poor job. Younger surgeons have 1.57 times odds of fulfilling these expectations. By comparison, middle-aged surgeons are 1.41 times as likely to meet them. This brings into question the influence of operational expertise as opposed to age-induced changes on surgical results.
The analysis looked at all types of lumbar spine surgeries. It indicates that only 24% of patients are receiving their operations from the younger surgeons and under one half (48%) of patients are being operated on by middle-aged surgeons. Older surgeons, who still do the vast majority of these procedures, operate on only 28% of patients. Though there may be different ways of setting expectations for patients, the objective measures of disability and pain don’t change. Fifteen years later, surgeons of varying age groups continue to score equally for their patients’ surgical performance.
Surgical Demographics and Performance
The numbers show that elder surgeons are actually doing a mind-boggling 85.9% of all lumbar spine surgeries and 57.7% of all spinal fusions. Middle-aged surgeons perform 81.7% of lumbar surgeries and 49.6% of fusions. The large number of older practicing surgeons reflects the unique experience and invaluable contributions they continue to make in the field. It also begs the question of how aging will affect their surgical performance.
In fact, less experienced surgeons operate on just 5.2% of patients who have degenerative disk disease. Older surgeons practice on 17.2% of these complex cases. The relative contributions of older surgeons made 25.7% of surgeries for patients aged <45 years. By comparison, middle-aged surgeons do not assume more than 17.3% of cases in this age cohort. These numbers mean that older surgeons are more likely to operate on more complicated cases. They are more likely to manage age-related chronic conditions.
Patient Satisfaction and Future Considerations
According to patient-reported satisfaction scores, younger surgeons get higher ratings, with a 1.29 adjusted odds ratio. This finding points to an unexpected relationship between a surgeon’s age and the likelihood their patients will report being satisfied or very satisfied. We could go back and forth indefinitely, but younger surgeons do improve care in many ways, such as their possession of new technologies and experiences. Age-related changes could compromise their ability to perform.
“Older surgeons contribute valuable experience and expertise; however, they are subject to age-related changes in vision, movement, and cognition and the stress associated with the evolution of techniques and equipment in their field of practice.” – investigators
While these results are alarming, it is important to contextualize the narrative around surgeon age with a lens that fights against discrimination and ageism. As the demand for qualified surgeons only increases, it becomes all the more important to protect the rights and abilities of qualified practitioners to serve all patients.
“Although it is essential to identify physicians with impaired abilities to perform their duties, this must be balanced with protecting colleagues from discrimination and ageism, especially in an era where the need for surgeons is ever-increasing.” – investigators
While the study authors continue to advocate for more research exploring qualitative patient outcomes. As a result, we will gain insight into why younger surgeons are more likely to report high satisfaction rates.
“Future research should focus on qualitative patient outcomes to further determine why younger surgeons’ satisfaction rates are slightly higher.” – researchers
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