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Experience Doesn't Always Mean Surgical Success

Research * In a study of a common procedure, older doctors' patients have a higher death rate.


Experience may not be all it's cracked up to be, especially when it comes to performing surgery.

Researchers have found that older doctors performing a common surgery to prevent strokes are more likely to lose their patients than their younger counterparts.

The study, published in the September issue of the journal Neurology, found that patients of doctors licensed for more than 20 years had a higher mortality rate during a carotid endarterectomy than the patients of less-experienced surgeons.

The operation removes plaque in one of the arteries that supply blood to the brain, because the blockages can come loose and cause a stroke. The operation, itself, however, could send plaque to the brain, causing a stroke.

"One real and concerning possibility that older surgeons may be performing worse is that they may not be incorporating new techniques," said Dr. Douglas Lanska, a professor of neurology at the University of Wisconsin and one of the study's three authors. "Or their skill may be declining."

Another of the study's authors suggested that older doctors may depend more on resident staff during the surgery.

"Given that we've also found similar findings for bypass surgery, it raises questions for other surgeries in general. For example, it might warrant more frequent training and recertification," said Liam O'Neill, an assistant professor of policy at Cornell University. He said further studies are planned.

A lack of experience was a factor only when surgeons performed two or less surgeries during a two-year period, the study found. This group of doctors lost the greatest number of patients--2 out of 100, as opposed to older doctors, who lost about 1 out of 100. The average mortality rate in the study was 0.7%.

Among doctors who performed more than three surgeries a year, however, the number of patients who died was similar whether a doctor performed a high volume of operations or a small number.

Patients of neurosurgeons were the least likely to die.

The study was based on almost 13,000 surgeries performed by 532 doctors over a two-year period in Pennsylvania.

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