Results from a retrospective cohort study found that patients treated by female surgeons had lower rates of adverse postoperative outcomes, including death, than patients treated by male surgeons.
Study design
This study, conducted in Ontario, Canada, compared outcomes from 25 common surgical procedures in 10 surgery specialties conducted by female surgeons (n = 151,054 patients; 13% of the cohort) vs those conducted by male surgeons (n = 1,014,657 patients; 87% of the cohort). Surgeries took place between January 2007 and December 2019. The primary endpoint was adverse postoperative outcomes, defined as a composite of death, hospital readmissions, and complications (i.e., need for repeat surgery), at 90 days and 1 year after surgery.
Outcomes
At 90 days, 13.9% of patients operated on by male surgeons and 12.5% of patients operated on by female surgeons had ≥1 postoperative outcomes, with rates increasing to 25.0% and 20.7%, respectively, at 1 year. Mortality rates were also lower for patients operated on by female surgeons, at both the 90-day and 1-year timepoints. Of note, only 1 of the 10 surgery specialties, general surgery, had similar representations of male and female surgeons (31.9% and 40.8%, respectively).
Limitations
There was a significant disparity in the number of patients operated on by male surgeons and by female surgeons. While the level of complexity of cases and surgery procedure type (elective vs urgent) was similar between male surgeons and female surgeons, there were also notable differences between patients treated by male and female surgeons, many related to the unequal distribution of women in the surgical workforce. However, the authors suggest that other differences may relate to differences in the way that female and male surgeons practice, implicating them along the causal pathway rather than as confounders. In addition, the authors combined 10 surgery specialties in which there is an unequal representation between male surgeons and female surgeons.
Clinical significance
The authors state that this is the first study to evaluate the relationship between surgeons’ sex and postoperative outcomes beyond 30 days. Patients treated by female surgeons had significantly lower long-term rates of adverse postoperative outcomes than patients treated by male surgeons, and these findings add to the growing published data showing that patients cared for by female physicians (including surgeons) appear to fare better than those being cared for by male physicians. Despite these data, the authors point out that women continue to be marginalized in the workplace in many ways. To provide the best patient care, organizations should investigate these outcome differences further and provide more equitable support to female physicians. Additional studies should be done to better ascertain how the improved outcomes were achieved.
Financial Disclosures: Dr. Jennifer Galvin discloses no financial relationships.