Older spine surgeons treated more complex cases than younger peers and achieved similar patient functional outcomes but still received lower patient satisfaction scores in a new study.
In a retrospective cohort study of more than 3000 adult patients who underwent elective surgery for degenerative spine conditions, there were no significant differences on objective measures of disability and pain 12 months later among younger (35-44 years), middle-aged (45-59 years), or older (60 years or older) surgeons.
However, on the subjective measure of “expectations fulfilled,” patients gave higher scores if treated by younger or middle-aged surgeons than by older ones and reported a higher satisfaction level if treated by younger surgeons.
Still, the results suggest that “spine surgeons of all ages are a valuable resource,” due to similar patient outcomes, lead study author Brett Ells, MD, Dalhousie University, Halifax, Nova Scotia, Canada, and colleagues wrote.
The results were published online on April 21 in JAMA Network Open.
How Important Is Age?
The investigators reported they had set out to determine whether surgeon age really is linked to outcomes after spine surgery.
“Older surgeons contribute valuable experience and expertise; however, they are subject to age-related changes in vision, movement, and cognition and the stress associated with the evolution of techniques and equipment in their field of practice,” they wrote.
“Although it is essential to identify physicians with impaired abilities to perform their duties, this must be balanced with protecting colleagues from discrimination and ageism, especially in an era where the need for surgeons is ever-increasing,” they added.
The researchers analyzed data from the Canadian Spine Outcomes and Research Network of 3421 adult patients (53% men).
All patients completed several questionnaires at baseline and at 1 year after undergoing elective surgery because of a degenerative diagnosis. Degenerative spine conditions in the participants included spinal stenosis, degenerative disk disease, disk herniation, and spondylolisthesis.
Among the patient population, 48% were treated by middle-aged surgeons, 28% were treated by older surgeons, and 24% were treated by younger surgeons.
Disability was measured using the Ostwestry Disability Index (ODI) and Neck Disability Index (NDI). Back/neck and arm/leg pain levels were also measured.
More Complex Cases, but Less Satisfaction
Results showed that older surgeons performed significantly more lumbar spine surgeries (85.9% vs 81.7%; P = .01) and more fusions (57.7% vs 49.6%; P = .003) than middle-aged surgeons, and they operated on more patients younger than 45 years (25.7% vs 17.3%; P < .001) and saw more patients with degenerative disk disease (17.2% vs 5.2%; P < .001) than younger surgeons.
Older surgeons also performed more surgeries of high invasiveness, as measured by the spine surgical invasiveness index (SSII) than surgeons younger than 60 years (28.9% vs 23.4%; P = .02). The higher the SSII, the more complicated the surgical case, investigators noted.
There were no significant differences among groups on patient-reported adjusted combined mean ODI and NDI disability scores (ranging from 24.6 to 25.8) and on adjusted mean pain scores (ranging from 3.3 to 3.4) at 12 months post-procedure.
However, patients were more likely to have all of their expectations met if treated by younger or middle-aged surgeons (adjusted odds ratios [aORs], 1.57 and 1.41, respectively; P = .049) than by older surgeons.
Patient-reported satisfaction scores were more likely to be higher for younger surgeons (aOR, 1.29; P = .03) than for middle-aged or older surgeons.
Investigators noted that differences by age group in expectation and satisfaction scores may be due to increased attention in medical school training on patient communication.
“Future research should focus on qualitative patient outcomes to further determine why younger surgeons’ satisfaction rates are slightly higher,” the researchers wrote.
Several of the investigators reported receiving multiple grants and/or personal fees from a variety of organizations and companies. Full details are listed in the original article.