Gradual physiological and cognitive decline generally occur after the age of 65, although age-related deterioration can vary widely from individual to individual.

In yesterday’s Town Hall session, When Is the Surgeon Too Old to Operate?, attendees discussed factors for determining whether a surgeon should continue to operate.

An ACS position statement released in 2016 recommends physical, visual, and neurocognitive testing for late-career surgeons. According to the statement, surgeons should “undergo voluntary and confidential baseline physical examination and visual testing by their personal physician for overall health assessment. Regular interval reevaluation thereafter is prudent for those without identifiable issues on the index examination.”

Although it is difficult to determine whether senior surgeons have poorer outcomes overall compared with younger surgeons, older surgeons are able to draw on decades of experience when making critical decisions in the operating room.

“Being too old to operate is not the same thing as retiring,” said Town Hall moderator Anton N. Sidawy, MD, MPH, FACS, DFSVS, MAMSE, Chair of the ACS Board of Regents. “You can assist in the OR, you can teach…but make sure you have a plan for what you want to do next. There are lots of things we cannot control in the [aging] process, but this is something that you can control.”

Dr. Sidawy asked attendees, by a show of hands, if the College should recommend an age to stop operating or if the organization should set an age requirement to begin testing. Only a handful supported the former, while the majority of attendees supported guidance from the ACS on when a senior surgeon should begin physical and cognitive testing. Specifically, attendees called on the College to expend additional resources on developing more accurate and reliable assessments.

In addition to testing, Town Hall participants emphasized the need for a multifaceted approach to evaluating a surgeon’s performance and potential age-related decline, including coaching senior surgeons on developing enhanced self-awareness, recognizing subtle cues, and accepting feedback from colleagues and team members.

Dr. Sidawy noted that the Society of Surgical Chairs is developing a white paper, “Transitioning the Senior Surgeon,” which will provide guidance for assessment of technical performance and strategies for managing the emotional and financial concerns of aging surgeons.

Senior surgeons play a valuable role in their practices, hospitals, and communities and can continue to contribute to the care of the surgical patient through teaching, surgical assisting, research, and leadership.