Comparison of short term surgical outcomes of male and female gastrointestinal surgeons in Japan: retrospective cohort study

Abstract

Objective To compare short term surgical outcomes between male and female gastrointestinal surgeons in Japan. Design Retrospective cohort study. Setting Data from the Japanese National Clinical Database (includes data on >95% of surgeries performed in Japan) (2013-17) and the Japanese Society of Gastroenterological Surgery. Participants Male and female surgeons who performed distal gastrectomy, total gastrectomy, and low anterior resection. Main outcome measures Surgical mortality, surgical mortality combined with postoperative complications, pancreatic fistula (distal gastrectomy/total gastrectomy only), and anastomotic leakage (low anterior resection only). The association of surgeons’ gender with surgery related mortality and surgical complications was examined using multivariable logistic regression models adjusted for patient, surgeon, and hospital characteristics. Results A total of 149 193 distal gastrectomy surgeries (male surgeons: 140 971 (94.5%); female surgeons: 8222 (5.5%)); 63 417 gastrectomy surgeries (male surgeons: 59 915 (94.5%); female surgeons: 3502 (5.5%)); and 81 593 low anterior resection procedures (male surgeons: 77 864 (95.4%); female surgeons: 3729 (4.6%)) were done. On average, female surgeons had fewer post-registration years, operated on patients at higher risk, and did fewer laparoscopic surgeries than male surgeons. No significant difference was found between male and female surgeons in the adjusted risk for surgical mortality (adjusted odds ratio 0.98 (95% confidence interval 0.74 to 1.29) for distal gastrectomy; 0.83 (0.57 to 1.19) for total gastrectomy; 0.56 (0.30 to 1.05) for low anterior resection), surgical mortality combined with Clavien-Dindo grade ≥3 complications (adjusted odds ratio 1.03 (0.93 to 1.14) for distal gastrectomy; 0.92 (0.81 to 1.05) for total gastrectomy; 1.02 (0.91 to 1.15) for low anterior resection), pancreatic fistula (adjusted odds ratio 1.16 (0.97 to 1.38) for distal gastrectomy; 1.02 (0.84 to 1.23) for total gastrectomy), and anastomotic leakage (adjusted odds ratio 1.04 (0.92 to 1.18) for low anterior resection). Conclusion This study found no significant adjusted risk difference in the outcomes of surgeries performed by male versus female gastrointestinal surgeons. Despite disadvantages, female surgeons take on patients at high risk. Greater access to surgical training for female physicians is warranted in Japan.

Differences in Cholecystectomy Outcomes and Operating Time Between Male and Female Surgeons in Sweden

“…3 In comparison, the percentage of female surgeons in the UK and Japan was 27% and 22%, respectively. 4,5 The practice of medicine is known to vary between female and male physicians, [6][7][8][9] but less is known about whether female and male surgeons differ in surgical techniques or outcomes. A Canadian study of 25 different surgical procedures showed a slightly decreased 30-day mortality but similar surgical outcomes in patients treated by female vs male surgeons.…”

Redefining the professional identity of the surgeon

“…The study conducted by Okoshi and colleagues1 supports the claim that female surgeons can achieve as good outcomes as male surgeons and raises the question of why, when most medical school entrants are women, they remain under-represented in surgical specialties. The existing literature indicates several structural barriers, such as shift patterns, lack of part time employment opportunities, and the effects of maternity leave on career progression, as well as cultural barriers, such as the belief that surgery is “an old boys’ club” and the dominant stereotype of the surgeon that comprises traditionally male characteristics 23…”

The role of Gender in Operative Autonomy in orthopaedic Surgical Trainees (GOAST)

“…6,7 Despite this, patients treated by female surgeons do as well if not better in terms of early survival, hospital readmissions, and complications. 8,9 Total cases as both lead surgeon and as lead surgeon without direct supervision (autonomous operating) have been used as a marker of quality of surgical training and readiness for indpendent practice. 10,11 It is generally expected that trainees will progress from operating as lead surgeon under supervision to operating independently, or training junior trainees for all core speciality procedures by the end of their training.…”

“…6,7 Despite this, patients treated by female surgeons do as well if not better in terms of early survival, hospital readmissions, and complications. 8,9…”