Surgical Outcomes and Patient Expectations and Satisfaction in Spine Surgery Stratified by Surgeon Age
Authors: Brett Ells, Mayilee Canizares, Raphaële Charest-Morin, Andrew Nataraj, Chris Bailey, Eugene Wai, Alex Soroceanu, Travis Marion, Marcel Dvorak, Y. Raja Rampersaud, Charles Fisher, Zhi Wang, Naj Attabib, Sean Christie, Nicholas Dea, Adrienne Kelly, Supriya Singh, Bernard Larue, Michael Weber, Chris Small, Hamilton Hall, R. Andrew Glennie
Journal: JAMA Network Open (2025)

Importance There is a paucity of data comparing patient-reported outcomes across surgeon age. Prior work has focused on adverse event rates for surgeon age across a variety of surgical procedures. Objective To compare patient-reported outcomes, expectation fulfillment, and satisfaction measures after spine surgery across surgeon age categories. Design, Setting, and Participants This retrospective cohort study was conducted at multicentered tertiary referral centers across Canada. Patients with degenerative conditions of the spine were enrolled in a national research network from January 2015 to August 2020. Patients were linked to a demographic survey distributed to spine surgeons who enrolled the patients. Elective surgery for degenerative spine conditions were followed up for a minimum of 1 year after operation. The data were analyzed in January 2024. Exposure Surgeons were classified according to their age: younger (age 35-44 years), middle age (45-59 years), and older (≥60 years). Main Outcome and Measures The primary outcomes were the Ostwestry Disability Index (ODI) and Neck Disability Index (NDI), numerical pain scores, expectation fulfillment, and overall satisfaction with spine surgery. Baseline demographic and clinical data and surgical procedure complexity were collected. Multivariate logistic regression models were employed, using generalized estimating equations to account for clustering within surgeons, to compare patient outcomes, expectation fulfillment, and satisfaction by surgeon age. Results A total of 3421 patients (1236 [36.1%] aged 65 years or older; 1603 female [46.9%]) were included in the study for analysis, with 811 (23.7%) treated by younger surgeons, 1643 (48.0%) by middle-age surgeons, and 967 (28.3%) by older surgeons. There were 2857 procedures of the lumbar spine (83.5%). After accounting for patient demographic, clinical, surgical, and surgeon characteristics, there were no significant differences in disability and pain (ODI and NDI or pain score) at 12 months among younger (mean ODI and NDI score, 25.6; 95% CI, 24.3-26.9; mean pain score, 3.4; 95% CI, 3.2-3.6), middle-age (mean ODI and NDI score, 25.8; 95% CI, 24.9-26.8; mean pain score, 3.3; 95% CI, 3.2-3.4), and older (mean ODI and NDI score, 24.6; 95% CI, 23.4-25.8; mean pain score, 3.4; 95% CI, 3.2-3.6) surgeons. Patients treated by younger (adjusted odds ratio [aOR], 1.57; 95% CI, 1.02-2.40) and middle-age (aOR, 1.41; 95% CI, 1.06-1.86) surgeons reported having all their expectations fulfilled compared with older surgeons. Additionally, patients treated by younger surgeons reported higher satisfaction levels (aOR, 1.29; 95% CI, 1.01-1.69) compared with middle-aged and older surgeons. Conclusions and Relevance In this retrospective cohort study of patients who underwent elective spine surgery, there was no difference in outcomes by surgeon age at 1 year, but patients treated by younger surgeons reported higher levels of satisfaction and expectation fulfillment. These findings suggest that spine surgeons of all ages are a valuable resource given similar patient outcomes for all groups.