How old is too old for the operating room?  As surgeons age, questions arise about the physical fitness needed to provide good surgical care.

According to a recent piece in the Journal of the American Medical Association (JAMA), approximately 44 percent of the active surgeons in the US are 55 years of age or older.  The pros and cons of age cut both ways. Older physicians are more experienced while at the same time they are vulnerable to the age-related impacts that plague us all, like slower reaction time, diminished eyesight, and less physical stamina.

In the JAMA article, study authors explore the need to create a test or evaluation process the capabilities of older surgeons.  They note “Research shows that between ages 40 and 75 years, the mean cognitive ability declines by more than 20%, but there is significant variability from one person to another, indicating that while some older physicians are profoundly impaired, others retain their ability and skills.”

The article goes on to remark that other professions in the US are subject to age-related requirements for retirement or testing, including airline pilots, firefighters, and air traffic controllers.  So what about surgeons?

Aging Surgeons—an Asset or a Liability?

As individuals, surgeons must have excellent hand-eye dexterity, focus, stamina, and depth engagement in each moment of their surgery day.  As a profession, surgeons have responsibility to the patients and communities they serve.

In a study of malpractice data, researchers from Johns Hopkins estimated about 80,000 surgical “never events” occurred in the US between the years 1990 to 2010.  “Never events” are those that the medical profession believes should never occur—like leaving objects within the body of a surgical patient, operating on the wrong patient, or on the wrong body part.  At the time, study authors thought the estimate was probably low for what is actually happening at hospitals across the country, and the research did not distinguish between the ages of operating surgeons.

Any surgical patient is already at risk for surgical mistake or complications of surgery.  Older surgeons bring other variables to the equation, including:

  • Remoteness of education: Trained decades earlier, older physicians may be operating by a different surgical playbook than surgeons trained in newer techniques and technology.  While an older physician may still have superior ability, he or she may simply be out of date with current medical knowledge of how to save life and limb.
  • Physical ability: Cognitive and physical decline may impair decision-making capabilities or reduce ability to see, hear, focus, and make intensely complex motor movements.
  • Experience: The experience of an older surgeon can be invaluable.  Although an aging surgeon could be out of date in theory, their decades in practice provide an immense wealth of knowledge.

In fact, an observational study using Medicare data of patients treated by more than 45,000 surgeons found that patients treated by older physicians had a lower mortality rate.

As a group, surgeons have not yet called for, or validated mandatory assessment programs to identify which and when surgeons should exit the operating theater.  Failing that, it may be time for state and federal legislative bodies to take up the conversation of “how old is too old” for surgical specialists.

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