Surgeon Sex and Long-Term Postoperative Outcomes Among Patients Undergoing Common Surgeries

[Mij]

Key Points

Question Is there an association between surgeon sex and patients’ long-term postoperative outcomes?

Findings In this cohort study of 1 million patients, those treated by a female surgeon were less likely to experience death, hospital readmission, or major medical complication at 90 days or 1 year after surgery. This association was seen across nearly all subgroups defined by patient, surgeon, hospital, and procedure characteristics.

Meaning The findings of this study suggest that patients treated by female surgeons have a lower risk-adjusted likelihood of adverse postoperative outcomes at 90 days and 1 year following surgery.

Abstract
Importance Sex- and gender-based differences in a surgeon’s medical practice and communication may be factors in patients’ perioperative outcomes. Patients treated by female surgeons have improved 30-day outcomes. However, whether these outcomes persist over longer follow-up has not been assessed.

Objective To examine whether surgeon sex is associated with 90-day and 1-year outcomes among patients undergoing common surgeries.

Design, Setting, and Participants A population-based retrospective cohort study was conducted in adults in Ontario, Canada, undergoing 1 of 25 common elective or emergent surgeries between January 1, 2007, and December 31, 2019. Analysis was performed between July 15 and October 20, 2022.

Exposure Surgeon sex.

Main Outcomes and Measures An adverse postoperative event, defined as the composite of death, readmission, or complication, was assessed at 90 days and 1 year following surgery. Secondarily, each of these outcomes was assessed individually. Outcomes were compared between patients treated by female and male surgeons using generalized estimating equations with clustering at the level of the surgical procedure, accounting for patient-, procedure-, surgeon-, anesthesiologist-, and facility-level covariates.

Results Among 1 165 711 included patients, 151 054 were treated by a female and 1 014 657 by a male surgeon. Overall, 14.3% of the patients had 1 or more adverse postoperative outcomes at 90 days and 25.0% had 1 or more adverse postoperative outcomes 1 year following surgery. Among these, 2.0% of patients died within 90 days and 4.3% died within 1 year. Multivariable-adjusted rates of the composite end point were higher among patients treated by male than female surgeons at both 90 days (13.9% vs 12.5%; adjusted odds ratio [AOR], 1.08; 95% CI, 1.03-1.13) and 1 year (25.0% vs 20.7%; AOR, 1.06; 95% CI, 1.01-1.12). Similar patterns were observed for mortality at 90 days (0.8% vs 0.5%; AOR 1.25; 95% CI, 1.12-1.39) and 1 year (2.4% vs 1.6%; AOR, 1.24; 95% CI, 1.13-1.36).

Conclusions and Relevance After accounting for patient, procedure, surgeon, anesthesiologist, and hospital characteristics, the findings of this cohort study suggest that patients treated by female surgeons have lower rates of adverse postoperative outcomes including death at 90 days and 1 year after surgery compared with those treated by male surgeons. These findings further support differences in patient outcomes based on physician sex that warrant deeper study regarding underlying causes and potential solutions.


https://jamanetwork.com/journals/jamasurgery/article-abstract/2808894

https://www.upi.com/Health_News/2023/08/30/female-surgeons-better-outcomes/1861693415388/

 

[Arnie Pye]

I would have suggested using "gender" rather than "sex" throughout. I was quite startled by the title when I first read it.

 

[duncan]

I would have suggested using "gender" rather than "sex" throughout. I was quite startled by the title when I first read it.

I cannot begin to relay how I misconstrued the title.

 

[perchance dreamer]

I cannot begin to relay how I misconstrued the title.

Me, too! My sister's married to a surgeon, and she's never mentioned anything.

 

[Trish]

Me too, especially since there was recent news in the UK about the shocking prevalence of senior male surgeons misusing their power over the careers of their junior female colleagues to force them into sex.

 

[Creekside]

Is this the start of a trend of news items about studies finding correlations that either aren't important or which aren't likely to result in any useful improvements? "Hospitalizations for broken hips occur less during daylight hours!!!" While there may be a valid correlation between surgery outcomes and surgeon gender (and maybe patient gender vs surgeon gender) it's probably not a factor that can be applied to improve outcomes. Maybe the correlation is due to male surgeons drinking more beer while at medical school, or being more likely to think about sports during surgery; factors that would be difficult to alter.

Is there anyone that didn't misconstrue the title?

 

[boolybooly]

Definitely boggled a bit over that title.

But this is about institutionalised grandiosity, callousness, complacency and cavalier attitudes inherited from the 18th century isn't it?

A brotherhood of high status reluctant to face their own shortcomings, closing ranks to protect their privileges and using academic hauteur to deflect criticism.

It was the same over hand washing.

From a zoological perspective, brotherhoods appear to be a facet of human nature possibly due to our apparent evolution in accord with the male philopatric model, where males bond to defend and control a territory and its resources, the rewards of which are then divvy'd up within the male heirarchy according to status.

What I would point out is this kind of brotherhood is a clique within a professional body which does hold itself to higher standards, like a frat house within a university, it does not exactly set the standard but it is tolerated, widespread and influential.

I expect this will rumble on but I think the frat house rules will eventually be reformed because it looks as though it is costing patients lives, which cant be good.

I am looking forward to the era of AI epidemiology... which cant be far away now... when people, places, machines, instruments, methods and treatments will be analysed and judged for efficacy. It is a strange new world which is coming.