Oral Posters: Thoraco-lumbar Degenerative

Presented by: J. Zigler - View Audio/Video Presentation (Members Only)

Author(s):

J. Zigler(1), R. Guyer(1)

(1) Texas Back Institute, Plano, TX, United States

Abstract

Introduction: Aging is inevitable and is often accompanied by gradual loss of stamina and physical skills, although each individual ages differently. While many embrace retirement and are happy to exit the workforce, making this decision appears be a challenge for many surgeons. Is there a potential risk to patients undergoing surgery by low volume ageing surgeons or a definable point at which spine surgeons should retire, either age or number of cases performed annually? The purpose of this study was to get feedback from spine surgeons on retiring from practice.

Methods: A survey was sent to the surgeon members of ISASS asking about the number of cases that a surgeon should perform to remain proficient and also about retirement age for spine surgeons. Responses were anonymous.

Results: Responses were received from 100 spine surgeons of 1,236 survey recipients (8.1%). The group responding was composed of 74% orthopaedic surgeons and 26% neurosurgeons. The majority of those responding to the survey had been in practice more than 20 years (67%). With respect to the number of cases they performed per year, 47% indicated more than 200 cases, with 39% indicating performing between 100 and 200 cases annually. When asked about the number of cases per year necessary to perform to maintain a spine surgeon's skills and competence to operate, the majority (77%) selected 51 to 150 cases, 13% felt more than 150 cases per year were needed and 10% thought less than 50 was acceptable. Provided in Figure 1 are the responses to the question if there should be a mandatory retirement age for surgeons, similar to commercial pilots (age 65 yrs). The majority of respondents selected that there should not be a mandatory retirement age.

Discussion: The majority of spine surgeons participating in the survey indicated that there should not be a mandatory retirement age for surgeons. An argument may be made that aging surgeons may present an increased risk to patients and liability to their practices and/or hospitals if their surgical caseload falls below 50 cases per year, according to 90% of experienced spine surgeons. It should also be noted that these are the subset with the greatest experience in their profession. To date, there is no evaluation to determine how an aging surgeon's skills are maintained for the type of cases he/she performs. It is hoped that this survey serves as a starting point for further consideration and discussion concerning when should spine surgeons cease operating, and offers an objective number of annual cases as a cut-off point.

Fig. 1. Responses on mandatory retirement age.]