3 ms·

Not going to talk about this generally, but this may not be the case for surgeons, and it depends on the procedure etc. This was one study showing that surgical

by conorh 11y ago

Not going to talk about this generally, but this may not be the case for surgeons, and it depends on the procedure etc. This was one study showing that surgical volumes improved outcomes: http://www.nejm.org/doi/full/10.1056/NEJMsa012337 http://www.nejm.org/doi/full/10.1056/NEJMsa012337

thelettere 11y ago
That study was on hospitals though - although yes the same applies for surgeons (1), and obstetricians [although the benefits begin to deteriorate at around 50 (2)]. But cardiologists were what the original study was on, and they don't perform surgery. Rather, they are relied on for their "expert judgement", a highly questionable concept (3). (1) http://www.sciencedirect.com/science/article/pii/S174391911301008X http://www.sciencedirect.com/science/article/pii/S1743919113... (2) http://www.bmj.com/content/344/bmj.d8041.short http://www.bmj.com/content/344/bmj.d8041.short (3) https://www0.gsb.columbia.edu/mygsb/faculty/research/pubfiles/1152/Process_and_performance_of_experts.pdf https://www0.gsb.columbia.edu/mygsb/faculty/research/pubfile...
- conorh 11y ago
  Sorry yes, wasn't saying anything about cardiologists, just wanted to point out that surgery might be different. I'm familiar with the second study you mention there - I'd take it with a large grain of salt! It highlights the issues with so many medical studies and how hard they are to get right with limited data. The study attempts to generalize surgeon performance based on age for only 22 surgeons that did 'enough' operations that year (for one complication, only 15 for the other), while trying to account for all the other factors (patients, difficulty of operation etc.), and not accounting for the wildly varying volumes for each surgeon and the fact that the study had a large cluster of younger doctors, and not many older doctors (look at the plots) It just doesn't have enough data to be a good study in what they attempted.
  - thelettere 11y ago
    Ah, good point. That's why I try to stick to reviews or meta-analysis, but was too lazy to look more that time, especially since it sounded right. Do you know at what age surgical skill starts to drop due to aging? I found a review that talked about how older surgeons stop taking on more challenging cases, which was interesting - but it didn't mention anything about that.

by conorh 11y ago

thelettere 11y ago

That study was on hospitals though - although yes the same applies for surgeons (1), and obstetricians [although the benefits begin to deteriorate at around 50 (2)]. But cardiologists were what the original study was on, and they don't perform surgery. Rather, they are relied on for their "expert judgement", a highly questionable concept (3). (1) http://www.sciencedirect.com/science/article/pii/S174391911301008X http://www.sciencedirect.com/science/article/pii/S1743919113... (2) http://www.bmj.com/content/344/bmj.d8041.short http://www.bmj.com/content/344/bmj.d8041.short (3) https://www0.gsb.columbia.edu/mygsb/faculty/research/pubfiles/1152/Process_and_performance_of_experts.pdf https://www0.gsb.columbia.edu/mygsb/faculty/research/pubfile...

conorh 11y ago
Sorry yes, wasn't saying anything about cardiologists, just wanted to point out that surgery might be different. I'm familiar with the second study you mention there - I'd take it with a large grain of salt! It highlights the issues with so many medical studies and how hard they are to get right with limited data. The study attempts to generalize surgeon performance based on age for only 22 surgeons that did 'enough' operations that year (for one complication, only 15 for the other), while trying to account for all the other factors (patients, difficulty of operation etc.), and not accounting for the wildly varying volumes for each surgeon and the fact that the study had a large cluster of younger doctors, and not many older doctors (look at the plots) It just doesn't have enough data to be a good study in what they attempted.
- thelettere 11y ago
  Ah, good point. That's why I try to stick to reviews or meta-analysis, but was too lazy to look more that time, especially since it sounded right. Do you know at what age surgical skill starts to drop due to aging? I found a review that talked about how older surgeons stop taking on more challenging cases, which was interesting - but it didn't mention anything about that.