of specialized centers where a battery of tests for neurocognitive function can be conducted in the form of a
neuropsychological assessment (see sidebar, this page).
The costs of such testing should be borne by the hospital
or medical staff, not the surgeon. These results cannot
be used in isolation to determine continuation or withholding of hospital and surgical privilege but should be
incorporated as an additional piece of information as part
of an overall evaluation as described earlier in this statement. Further research is required to develop accurate and
reliable screening tests to help identify surgeons who are
potentially experiencing age-related decline in cognition
and surgical skills.
•Decisions regarding hospital and operating room privileges should be made at the medical staff and/or hospital
level only after careful evaluation of all evidence available.
Medical staff bylaws and due process must be followed.
Strict confidentiality is essential. As always, the best interests of the patient remain the first priority, while at the
same time the confidentiality, dignity, and contributions
of the surgeon must be respected.
•Senior surgeons play a vital role in their hospitals and
communities, and their knowledge and years of experience can be valuable resources. Surgeons relinquishing
clinical roles can contribute significantly to teaching,
surgical assisting, research, or administration. If their
abilities permit, and if they are willing, they should be
given opportunities to contribute to these areas.
•All hospitals and facilities that deliver surgical care are
encouraged to develop policies as appropriate for their
institution in compliance with state and federal regulations. It also is expected that there will be local variations
that cannot be covered or predicted with this statement. ♦
currently based on the Halstead-Reitan
Neuropsychological Test Battery
The battery consists of seven subtests
with the following purposes:
• Category: Measure of abstracting ability
• Tactual performance: Measures
memory and localization
• Rhythm: Task is to discriminate between
like and unlike pairs of musical beats
• Speech sounds perception: Task is to
discriminate spoken syllables
• Finger tapping: Measure of manual dexterity
• Time sense: Task of reproducing movement from
sight as well as ability to estimate time span
• Trail making tests, Parts A and B: Measures
psychomotor speed and flexibility
The administration of this test battery
requires a highly trained examiner, typically
a neuropsychologist, and requires a full day
to complete. Interpretation requires the skills
and knowledge of a trained neuropsychologist.
This is the standard due to a high degree
of clinical and psychometric reliability
for most of the tests in the battery.
Surgeons are not immune to age-related decline in physical and
cognitive skills. Even so, the ACS does not favor a mandatory
retirement age because the onset and rate of age-related
decline in clinical performance varies among individuals.