Are Surgical Outcomes Better With MDs or DOs?

For Medicare patients, surgical outcomes were similar whether they had an MD or a DO surgeon, a claims analysis suggested.

After adjusting for patient factors and practice settings, there was no difference in the primary outcome of 30-day mortality between MDs and DOs, with adjusted mortality rates of 1.58% and 1.61%, respectively (P=0.37), according to Tara Russell, MD, MPH, PhD, of the University of California Los Angeles, and colleagues.

Nor were there any differences in secondary outcomes of 30-day readmission (6.47% for MDs and 6.60% for DOs, P=0.06) or length of stay (median 5.07 days for both, P=0.60), they reported in JAMA Surgery.

The findings are consistent with earlier research that showed no difference in mortality among MD or DO hospitalists, the authors noted.

“Taken together, this work should reinforce to policymakers, hospital leadership, physicians, and patients that any differences between the two U.S. medical school degree programs do not translate to quantifiable differences in the quality of inpatient care delivered by MD and DO physicians and surgeons,” they wrote.

Russell and colleagues conducted a retrospective cohort study of Medicare claims data for beneficiaries ages 65 to 99 treated at inpatient hospitals from Jan. 1, 2016 to Dec. 31, 2019. Patients had one of the 14 most common surgical procedures, including appendectomy, coronary artery bypass graft (CABG), hip replacement, knee replacement, hysterectomy, and others.

Overall, the study included 39,339 MD surgeons (90.1%) and 4,312 DO surgeons (9.9%). About 2.4 million surgical procedures were analyzed, and the majority (91.3%) were performed by MD surgeons.

MD surgeons were more likely to be male and older. DO surgeons were more likely to specialize in general surgery, orthopedics, and ob/gyn, while MD surgeons were more likely to specialize in cardiothoracic and vascular, colorectal, head and neck, neurosurgery, plastic surgery, and urology specialties.

DO surgeons were significantly more likely to operate on older patients, female patients, and Medicaid dual-eligible patients. They also performed a smaller proportion of elective surgeries, and were more likely to work in public hospitals and nonteaching hospitals.

In addition to finding no differences in 30-day mortality and readmissions, and length of stay, Russell and colleagues also found, in stratified analyses, no differences in mortality by subspecialty, surgical procedure, hospital characteristics, or patient characteristics (including racial/ethnic minorities and comorbidity burden).

Despite the lack of differences, “the fact remains that DOs do not match into surgical residencies at the same rate as MDs,” the researchers wrote. Indeed, they are more likely to go into primary care specialties including family medicine and pediatrics, the authors noted.

But DOs are growing in numbers, with one in four U.S. medical students attending an osteopathic program in 2021, the authors noted. And they’re increasingly going into surgery. In 2019, DOs made up 13.4% of surgery residents compared with 3% in 2010, Russell and colleagues said.

They concluded that their study “highlights the importance of assessing individual physicians based on their qualifications, experience, and patient outcomes, rather than solely on their degree.”

The study was limited by the fact that surgical volume was based only on Medicare cases, which may not reflect surgeons’ entire caseload, and that conclusions may not be generalizable to younger or privately insured patients or to outpatient procedures.

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