Comparison of postoperative outcomes among patients treated by male and female surgeons: a population based matched cohort study

Abstract

Objective To examine the effect of surgeon sex on postoperative outcomes of patients undergoing common surgical procedures.Design Population based, retrospective, matched cohort study from 2007 to 2015.Setting Population based cohort of all patients treated in Ontario, Canada.Participants Patients undergoing one of 25 surgical procedures performed by a female surgeon were matched by patient age, patient sex, comorbidity, surgeon volume, surgeon age, and hospital to patients undergoing the same operation by a male surgeon. Interventions Sex of treating surgeon.Main outcome measure The primary outcome was a composite of death, readmission, and complications. We compared outcomes between groups using generalised estimating equations.Results 104 630 patients were treated by 3314 surgeons, 774 female and 2540 male. Before matching, patients treated by female doctors were more likely to be female and younger but had similar comorbidity, income, rurality, and year of surgery. After matching, the groups were comparable. Fewer patients treated by female surgeons died, were readmitted to hospital, or had complications within 30 days (5810 of 52 315, 11.1%, 95% confidence interval 10.9% to 11.4%) than those treated by male surgeons (6046 of 52 315, 11.6%, 11.3% to 11.8%; adjusted odds ratio 0.96, 0.92 to 0.99, P=0.02). Patients treated by female surgeons were less likely to die within 30 days (adjusted odds ratio 0.88; 0.79 to 0.99, P=0.04), but there was no significant difference in readmissions or complications. Stratified analyses by patient, physician, and hospital characteristics did not significant modify the effect of surgeon sex on outcome. A retrospective analysis showed no difference in outcomes by surgeon sex in patients who had emergency surgery, where patients do not usually choose their surgeon. ConclusionsAfter accounting for patient, surgeon, and hospital characteristics, patients treated by female surgeons had a small but statistically significant decrease in 30 day mortality and similar surgical outcomes (length of stay, complications, and readmission), compared with those treated by male surgeons. These findings support the need for further examination of the surgical outcomes and mechanisms related to physicians and the underlying processes and patterns of care to improve mortality, complications, and readmissions for all patients.

Surgical gender gap: a curriculum concordance and career vector perspective

“…Differences persisted across eight common medical conditions and across patients’ severity of illness. These findings were recently echoed by Wallis et al 26 from Ontario, Canada, who found that after accounting for patient, surgeon and hospital characteristics, patients operated on by female surgeons had a small but statistically significant decrease in 30-day mortality, readmission rate and complications (5810 of 52 315, 11.1%, 95% CI 10.9% to 11.4%) compared with those treated by male surgeons (6046 of 52 315, 11.6%, 11.3% to 11.8%; adjusted OR 0.96, 0.92 to 0.99, p=0.02). No such UK data are available on gender-related surgeon performance, although the recent publication of UK surgeon outcome data27 will facilitate transparency and future analysis.…”

Are Women Really Better Physicians Than Men Are?

“…When each of those outcomes was examined individually, patients with female surgeons had a statistically significant 4% lower likelihood of death within 30 days of surgery (P = .04) than did patients with male surgeons; differences in readmissions and complications were not statistically significant. 19 In contrast to a finding of no association between the treating physician's sex and patient mortality in a smaller study (sample about 20 000) of relatively healthy patients in an outpatient setting by Jerant et al, 20 the much larger and more recent studies reported by Tsugawa et al 17 on hospitalized older medical patients and Wallis et al 19 on postoperative patients showed a 4% relative risk reduction in mortality for patients treated by female physicians. Although that relative difference in mortality is nominal, it should not be interpreted as negligible as it could add up to thousands of saved lives.…”

“…Armed with 2 studies 17,19 that support the assertion that practice patterns of female physicians are associated with lower patient mortality and hospital readmissions and one other study 18 that evidenced other beneficial outcomes (ie, receiving recommended cancer screening and diabetes care, more referrals to specialists, fewer emergency department visits), is it valid to conclude that female physicians are better than male physicians? Clearly, one cannot legitimately generalize to that extent on the basis of 3 studies.…”

Simulation-Based Mastery Learning of Flexible Bronchoscopy: Deciding Factors for Completion

“…This might explain why a lower learning outcome through less progress of the self-training is associated with a lower completion rate. Studies suggest though that females can achieve the same level of competence in surgical skills, and the initial difference in learning outcome evens out over time [20, 21]. …”