Association Between Surgeon Age and Patient Hemodynamic Instability in Pheochromocytoma Surgery: A Multicenter Cohort Study.

Objective: To quantify the association between surgeon age and intraoperative hemodynamic instability (IHI) occurrence during pheochromocytoma surgery.

Background: Surgeons must master technical and nontechnical skills to limit IHI occurrence during pheochromocytoma resection, a rare, complex surgery.

Methods: This retrospective cohort study included data from adult patients who underwent pheochromocytoma surgery undertaken by surgeons aged 30 to 65 in 8 high-referral university hospitals in France from 01/01/2000 to 12/31/2016. Surgeon experience was quantified using surgeon's age at the time of surgery, and performance was evaluated using IHI occurrence. GEE logistic regression models, adjusted for potential confounders related to the patient and surgical procedure, were used to determine the probability of IHI according to surgeon age, independently of the surgeon-anesthesiologist duo and each surgeon's annual surgical volume.

Results: Nine hundred ninety pheochromocytoma surgeries performed by 44 surgeons were analyzed. There was a concave relationship between surgeon age and IHI (P=0.012). Standardized rates of IHI were 71.7% (95% CI: 60.9%-82.6%) at 30 years, reached a minimum of 50.4% (45.9%-54.7%) at 48 years, and were 70.2% (55.7%-80.2%) at 65 years. Among low-volume surgeons, IHI occurrence was more likely in those aged 55 to 65 compared with those aged 45 to 55 [adjusted odds ratios=1.71 (1.04 to 2.80)]. Among high-volume surgeons, IHI was more likely to occur in surgeons aged 30 to 44 compared with those aged 45-55 [2.05 (1.10 to 3.83)].

Conclusions: Our results suggest that in pheochromocytoma surgery surgeon performance could peak at mid-career, and then plateau and decline. Solutions that help surgeons maintain performance throughout their careers might be beneficial.