11 January 2012

Surgeons aged between 35 and 50 provide the safest care

One of the most common medical procedure is surgery. All forms of surgery are considered invasive procedures. There are "noninvasive surgery" which usually refers to an excision that does not penetrate the structure being excised such as Lasik surgery or a radiosurgical procedure (irradiation of a tumor).

A study published on BMJ-British Medical Journal finds that surgeons aged between 35 and 50 years provide the safest care compared with their younger or older colleagues.

The findings raise concerns about ongoing training and motivation of surgeons during their careers.

Typically, experts reach their peak performance between the ages of 30 and 50 years or after about 10 years' experience in their specialty, but few studies have measured the association between clinicians' experience and performance.

So a team, led by Drs Antoine Duclos and Jean-Christophe Lifante from the University of Lyon in France, set out to determine the association between surgeons' experience and postoperative complications after thyroid surgery. Antoine Duclos, Assistant Professor of Public Health, University of Lyon, France and is currently based at the Center for Surgery and Public Health, Boston, USA

The study involved 3,574 thyroidectomies (removal of the thyroid gland) by 28 surgeons (with an average age of 41 years with an average length of experience of 10 years) at five French hospitals during a one-year period.

Video: About Thyroid Surgery

A thyroidectomy is a surgical operation that involves removing all or part of the thyroid gland. A thyroidectomy is performed when a patient is diagnosed with thyroid cancer or some other condition of the thyroid gland (such as hyperthyroidism). One of the complications of "thyroidectomy" is voice change and patients are strongly advised to only be operated on by surgeons who protect the voice by using electronic nerve monitoring. Most thyroidectomies are now performed by minimally invasive surgery using a cut in the neck of no more than 2.5 cms(1 inch).

Two major complications of thyroid surgery were measured 48 hours after surgery and again at least six months after surgery: permanent recurrent laryngeal nerve palsy (severe hoarseness) and hypoparathyroidism (damage to the parathyroid glands leading to low calcium levels, cramping and twitching).

Background information was recorded for all patients and surgeons were surveyed about their background and professional experience. Surgical performance was also adjusted by case mix (the type and complexity of cases being treated).

Patients were at higher risk of permanent complications following thyroid surgery when operated on by inexperienced surgeons and those in practice for 20 years or more.

When thyroid surgery was performed by surgeons in practice for 20 years or more, the probability of permanent complications increased considerably.

Surgeons between 35 and 50 years old (that is, with 5-20 years of practice since graduation) had better outcomes than their younger or older colleagues.

The authors point out that, other unknown or unmeasured factors may have explained part of the variation in complication rates, and these should be further explored.

However, they say their findings suggest that surgeons' performance varies over the course of their career and that a surgeon cannot achieve or maintain top performance passively by accumulating experience, which raises concerns about ongoing training and motivation throughout a career that spans several decades.


BMJ-British Medical Journal
University of Lyon
Center for Surgery and Public Health
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