The Problem of the Aging Surgeon: When Surgeon Age Becomes a Surgical Risk Factor

The question of when a surgeon should retire has been the subject of debate for decades. Both anecdotal evidence and objective testing of surgeons suggest age causes deterioration in physical and cognitive performance. Medical education, residency and fellowship training, and technology evolve at a rapid pace, and the older a surgeon is, the more likely it is he or she is remote from his or her initial education in his or her specialty. Research also shows surgeons are reluctant to plan for retirement. Although there is no federally mandated retirement age for surgeons in the United States, surgeons must realize their skills will decline, a properly planned retirement can be satisfying, and the retired surgeon has much to offer the medical and teaching community. The author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.     

The Pediatric Surgical Team: a Model for Increased Surgeon Index Case Exposure

Background/PurposeHigh surgical volume for both surgeons and hospital systems has been linked to improved outcomes for many surgical problems, yet case volumes per pediatric surgeon are diminishing nationally in complex pediatric surgery. We therefore sought to review our experience in a geographically isolated setting where a surgical team approach has been used to improve per-surgeon exposure to index pediatric surgical cases.MethodsAs a surgical group, we incorporated a surgical team approach to complex pediatric surgical cases in 2010. We obtained institutional review board approval to review our pediatric surgeon index case volume experience. We then compared our surgeon experience to published surgical volumes for complex pediatric surgical cases.ResultsA surgical team approach (2 or 3 board certified pediatric surgeons/urologists working as co-surgeons or assistant surgeon) was used in the majority of cases for tracheoesophageal fistula/esophageal atresia (77%), congenital pulmonary airway malformation (73.5%), cloaca (75%), anorectal malformation (43.6%) biliary atresia (77.8%), Hirschsprung's disease (51.9%), congenital diaphragmatic hernia (67.6%), robotic choledochal cyst (100%), and complex oncology (adrenal tumors, neuroblastoma, Wilms tumor and Hepatoblastoma surgery) (85–100%). Over the 5-year period, surgeon index case exposure for all index pediatric surgical cases was above the published national median for pediatric surgeons, except for in splenic operations when contrasted to published experience.ConclusionsA surgical team approach to complex pediatric surgery may help maintain exposure to adequate index case volumes. This model may be useful for maintaining competence in geographically-isolated practice settings and low-volume pediatric hospitals that provide surgical care; the model has implications for systems development and workforce allocation within pediatric surgery.Level of Evidence4     

Editorial Commentary: The Latarjet: Increased Shoulder Stability,and Increased Risk of Complications in Low Volume Practitioners

The Latarjet procedure is a well-established treatment for shoulder instability. It is traditionally used for recurrent instability with significant bone loss (i.e. >20%) or after failed soft tissue procedures. It can be done open or arthroscopically with either a subscapularis takedown or a split. It has good long-term results regarding recurrence and clinical outcomes. Unfortunately, it has higher complication rates in comparison to its alternative procedures such as arthroscopic Bankart repair or open Bankart repair. These complications may be due to the learning curve of performing the procedure and lack of proper training. The Latarjet procedure is a necessary tool to treat shoulder instability. We need better training and exposure to Latarjet procedures in residency, fellowship, and clinical practice so that more providers can do this procedure for our patients, but we need to do it more safely.