The most-experienced surgeons are not necessary the best surgeons, a new study from France suggests.
In the study, patients having thyroid surgery were at higher risk of complications if their operations were performed by a surgeon with either little experience or an abundance of it.
The safest care was provided by surgeons between the ages of 35 and 50, with five to 20 years' experience, the researchers said. Surgeries performed by this group were found to have the best outcomes.
The findings suggest surgeons cannot maintain their optimum performance simply by accumulating years of experience, the researchers said. Continuing to monitor surgeons throughout their careers, and providing retraining if necessary, may prevent their performance from slipping, the researchers said.
The study included only surgeons in the field of endocrinology, or hormone-producing glands. It was not clear whether the findings apply to doctors in other fields who perform different types of surgery.
Too little or too much experience
The researchers examined the outcomes of 3,574 thyroidectomies — surgeries that remove the thyroid gland from a patient's neck — performed over a year by 28 surgeons at five French hospitals. On average, the surgeons were 41 years old and had 10 years of experience.
Patients were assessed to see whether two major complications of thyroid surgery were still present six months after the operation: severe hoarseness and hypoparathyroidism, a condition in which the glands in the neck don't produce enough parathyroid hormone, which helps control calcium levels in the body. Low calcium levels can cause twitching and cramping.
Occurrence of both complications was quite rare, about 2 percent of all patients.
Surgeons with more than 20 years of experience were three times more likely to perform thyroid surgery that resulted in severe hoarseness , and seven times more likely to perform thyroid surgery that resulted in hypoparathyroidism, than were surgeons with five to 19 years of experience.
Surgeons with less than five years' experience were five times more likely to perform a surgery that resulted in hypoparathyroidism than were surgeons with five to 19 years' experience.
Decline in performance
More-practiced surgeons may experience a drop in performance from weariness, the researchers said.
In addition, the most-experienced surgeons may be saddled with more academic and administrative duties, which could “affect surgeons’ attention in the operating room and jeopardize patient safety,” the researchers said.
Failure to adopt new surgical techniques also might affect the performance of the experienced physicians. “Talent and experience are not enough to guarantee safe surgery if a surgeon does not possess the motivation and willingness to progress,” the researchers said.
The study is published online today (Jan. 10) in the British Medical Journal.
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