Comments on: Older surgeons have higher mortality rates http://www.unboundedmedicine.com/2006/08/23/older-surgeons-have-higher-mortality-rates/ Medicine as it must be: Unlimited Sat, 22 Nov 2008 11:10:03 +0000 http://wordpress.org/?v=2.6.2 By: Sid Schwab http://www.unboundedmedicine.com/2006/08/23/older-surgeons-have-higher-mortality-rates/#comment-7195 Sid Schwab Sun, 03 Sep 2006 20:58:33 +0000 http://www.unboundedmedicine.com/2006/08/23/older-surgeons-have-higher-mortality-rates/#comment-7195 I should add this: as an older surgeon, with a track record, I was (I think) less concerned about the effect of the occasional riskly patient on my overall record. It might well be, apropos the above comments, that a surgeon just starting out would prefer to be more selective. For good reason, unfortunately. I should add this: as an older surgeon, with a track record, I was (I think) less concerned about the effect of the occasional riskly patient on my overall record. It might well be, apropos the above comments, that a surgeon just starting out would prefer to be more selective. For good reason, unfortunately.

]]> By: Sid Schwab http://www.unboundedmedicine.com/2006/08/23/older-surgeons-have-higher-mortality-rates/#comment-7194 Sid Schwab Sun, 03 Sep 2006 20:56:54 +0000 http://www.unboundedmedicine.com/2006/08/23/older-surgeons-have-higher-mortality-rates/#comment-7194 I'm not surprised to see mortality relate to numbers of cases; but the older/younger aspect would be hard to explain -- after all, what good is a study if we can't learn from it? So the question needs to be separated on the basis of quantity, and re-compared. Also, the older I got, the more respect I had among some referring physicians: they sent me cases that were more complex -- people with more concommitant medical conditions, knowing that I'd operate carefully and rapidly and give very attentive postop care. So, if that's a general truism, it might be that older surgeons have a higher mix of such patients. On the other hand, there are undoubtedly docs and patients who prefer younger surgeons. Data such as these need very careful analysis in order to draw conclusion. I’m not surprised to see mortality relate to numbers of cases; but the older/younger aspect would be hard to explain — after all, what good is a study if we can’t learn from it? So the question needs to be separated on the basis of quantity, and re-compared. Also, the older I got, the more respect I had among some referring physicians: they sent me cases that were more complex — people with more concommitant medical conditions, knowing that I’d operate carefully and rapidly and give very attentive postop care. So, if that’s a general truism, it might be that older surgeons have a higher mix of such patients. On the other hand, there are undoubtedly docs and patients who prefer younger surgeons. Data such as these need very careful analysis in order to draw conclusion.

]]> By: JonMikel, M.D. http://www.unboundedmedicine.com/2006/08/23/older-surgeons-have-higher-mortality-rates/#comment-6914 JonMikel, M.D. Sun, 27 Aug 2006 07:26:46 +0000 http://www.unboundedmedicine.com/2006/08/23/older-surgeons-have-higher-mortality-rates/#comment-6914 Dr. Savatta: Exactly, it's a shame that Statistics and Epidemiology rather than being useful things to make a better world and living it's going to stop performing difficult operations by nice and kind surgeons. What is going on? Thanks for your kind comment Dr. Savatta:

Exactly, it’s a shame that Statistics and Epidemiology rather than being useful things to make a better world and living it’s going to stop performing difficult operations by nice and kind surgeons.

What is going on?

Thanks for your kind comment

]]> By: Domenico Savatta, MD http://www.unboundedmedicine.com/2006/08/23/older-surgeons-have-higher-mortality-rates/#comment-6850 Domenico Savatta, MD Sat, 26 Aug 2006 15:29:11 +0000 http://www.unboundedmedicine.com/2006/08/23/older-surgeons-have-higher-mortality-rates/#comment-6850 I havent read the entire piece and I am a younger surgeon (under 40), but I am not a big fan of operative mortality. When you are talking about surgeries such as a radical cystectomy, this is a big operation. More important to a surgeons mortality is who he chooses to operate on. I have performed 6 of these operations in patients older than 90. One has died at home within a month not due to technical problems. He was doing well and then had something happen to him, probably a sudden heart attack. By doing these high risk surgeries that most surgeons would not do themselves, I will likely have a higher mortality figure. Data that is kept like this has led heart surgeons to try to avoid the highest of risk patients and I am worried will force people like me to do the same. I havent read the entire piece and I am a younger surgeon (under 40), but I am not a big fan of operative mortality.

When you are talking about surgeries such as a radical cystectomy, this is a big operation. More important to a surgeons mortality is who he chooses to operate on.

I have performed 6 of these operations in patients older than 90. One has died at home within a month not due to technical problems. He was doing well and then had something happen to him, probably a sudden heart attack.

By doing these high risk surgeries that most surgeons would not do themselves, I will likely have a higher mortality figure. Data that is kept like this has led heart surgeons to try to avoid the highest of risk patients and I am worried will force people like me to do the same.

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