The ageing cardiac surgeon—neither a bane, nor a boon, but a problem that needs to be addressed

Abstract

The recently published editorial by Dr. Yadava [1] calls for a healthy debate as regards advancing age in cardiac surgery. A brief Google search reveals that life expectancy for India in 2020 is 69.73 years. The life expectancy for the USA, on the other hand, is 78.9 years in 2020, a difference of nearly a decade. What about Indian surgeons? Pandey et al., state the life expectancy for Indian doctors of just 59 years, much lesser than an average Indian [2]. Thus, “ageing” for an Indian cardiac surgeon may not mean the same as his counterpart in the USA, and thus, planningwell and planning early might help in the Indian context. The ageing surgeon and the surgeon being an added risk factor have been studied often. Anderson et al. [3] observed that patient outcomes for surgeons with the fewest years of experience were comparable to those of their mid-career and senior counterparts. Very senior surgeons had higher riskadjusted odds of major morbidity/mortality. They concluded that contemporary approaches to training, referral, mentoring, surgical planning, etc. could contribute to such outcomes. Patient safety should be the most important factor that should determine ending professional surgical practice in cardiac surgery. Age has an impact on one’s physical and cognitive skills but individual variation remains. Old age heralds disease like hypertension and diabetes mellitus, presbyopia and tremors, even coronary artery disease. Acuity and stamina take a hit. Dementia sets in. According to the World Health Organization, about 15% of those aged 60 suffer from a mental disorder. Cardiac surgeons cannot be immune to burnout in a long surgical career. Again, frequent complex cases, reoperations and deaths have a bearing. But then, does not the experience count? A senior surgeon may be way ahead in decision-making while choosing not to operate, weighing the risk benefit ratio far more accurately than his younger counterparts, thus avoiding a lengthy, complicated procedure, which could have otherwise led to possible morbidity and mortality. In a recent study by Sherwood et al. [4], 52 experts across four countries participated and perceived the need for a staged approach to assessing the performance of older surgeons and tailoring interventions. Most older surgeons made decisions regarding career transitions with self-awareness and concern for patient safety. Some older surgeons may benefit from additional guidance and support from employers and professional colleges. A few poorly performing older surgeons, on the other hand, who are recalcitrant or lack insight, may need regulatory action to protect patient safety. Participants perceived that personal fulfillment from work, lack of hobbies, financial pressures and poor retirement planning all contribute to delayed transitions to retirement. Two key roles for employers were identified: (1) appraising performance through annual performance reviews and credentialing activities and (2) managing performance through career planning and an active and timely response to concerns. Participants spoke about the lack of validated tools for assessing surgical * Sudipto Bhattacharya [email protected]