Do older surgeons have safer hands? A retrospective cohort study

Area of Science:

• Cardiology and Thoracic Surgery
• Transplantation Medicine
• Surgical Outcomes Research

Background:

• Complex surgeries like lung transplantation often exhibit a volume-outcome relationship.
• Factors at both the institutional and surgeon levels influence outcomes.
• Investigating these factors is crucial for improving patient care.

Purpose of the Study:

• To examine the volume-outcome relationship in lung transplantation over three decades.
• To assess the impact of surgeon age and experience on transplant outcomes.
• To determine the influence of cumulative unit activity and transplant timing on survival.

Main Methods:

• Analysis of prospectively collected data from adult lung transplant recipients (1987-2017).
• Utilized national mortality data and individual surgeon demographic information.
• Employed statistical analyses including logistic regression and survival analysis.

Main Results:

• Increased center experience and successive calendar years correlated with improved 5-year survival.
• Advancing surgeon age at transplant was associated with better 30-day and 5-year survival.
• No significant survival difference was observed based on recipient gender, individual surgeon, or weekday/weekend procedures.

Conclusions:

• A relationship exists between lung transplant unit volume, increasing surgeon age, and patient survival.
• Conversely, a direct volume-outcome relationship was not identified for individual surgeons.
• Findings underscore the significance of institutional learning curves and surgeon experience over time.