Surgeons aged 35-50 years tend to have fewer complications during thyroid removal surgery compared with their younger and older peers, results from a multicenter French study show.
The findings “suggest 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 extends several decades,” according to the study, which was published Jan. 11 in BMJ. “Solutions to help surgeons avoid poor outcomes could include simulation and proctoring in the early years of their careers, continuous monitoring of performance, and targeted retraining if appropriate. Individual feedback based on outcome indicators might increase awareness about performance and improve safety in surgical practice.”
The researchers, led by Dr. Antoine Duclos, assistant professor of public health at the University of Lyon, France, evaluated data from 3,574 thyroidectomies performed by 28 surgeons at five French hospitals between April 1, 2008, and Dec. 31, 2009, (BMJ 2012 Jan. 11 [Epub doi:10.1136/bmj.d8041]). The main outcome measure was the presence of two permanent major complications 6 months following thyroid surgery: recurrent laryngeal nerve palsy or hypoparathyroidism.
The surgeons had a mean age of 41 years and had been in practice for a mean of 10 years. After adjusting for patient and surgeon variables, the researchers found that surgical experience of 20 years or more was the only factor significantly associated with an increased probability of recurrent laryngeal nerve palsy (odd ratio 3.06) and hypoparathyroidism (OR 7.56). They also observed what they described as a “concave association between surgeons’ experience and their case mix adjusted performance, suggesting that surgeons aged 35-50 years provided the safest care.”
The researchers acknowledged that other unknown or unexamined factors may explain part of the variation in patient complication rates, including the combination of manual and intellectual skills acquired during a surgeon’s academic and professional training. “Future studies should be conducted with larger populations of surgeons in various settings and other surgical specialties to corroborate the potential link between experience and performance,” they advised. “Since a cross sectional study might be inappropriate to resolve a dynamic phenomenon, a recommended design would be to follow a particular cohort of surgeons over time.”
— Doug Brunk (on Twitter@dougbrunk)
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