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

Wallis, Christopher J. D.; Jerath, Angela; Aminoltejari, Khatereh; Kaneshwaran, Kirusanthy; Salles, Arghavan; Coburn, Natalie; Wright, Frances C.; Gotlib Conn, Lesley; Klaassen, Zachary; Luckenbaugh, Amy N.; Ranganathan, Sanjana; Riveros, Carlos; McCartney, Colin; Armstrong, Kathleen; Bass, Barbara; Detsky, Allan S.; Satkunasivam, Raj

doi:10.1001/jamasurg.2023.3744

Cited by 96 publications

(28 citation statements)

References 22 publications

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“…Two recent studies have confirmed that women surgeons performed better surgery and had a lower incidence of adverse reactions after surgery than men surgeons. [28,29] So we can speculated that women gastroenterologists might do a better job than men, have more favorable patient outcomes. Therefore, our study is likely to encourage more women to engage in work related to H. pylori and help them get more academic opportunities.…”

Section: Author Association By Gendermentioning

confidence: 99%

Trends in gender disparity in the field of Helicobacter pylori research from 2000 to 2020: A cross-sectional study

Shi,

Huang,

Tan

et al. 2023

Medicine

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Many studies have investigated gender disparity in scientific publications, but this has been poorly studied in the field of digestive diseases. This study aimed to determine the gender difference of first and senior authors in publications related to Helicobacter pylori (H. pylori) during the past 20 years. Data were derived from original articles published in the main journals of digestive diseases (Journal of Hepatology, Gut, Gastroenterology, American Journal of Gastroenterology, Endoscopy, Gastrointestinal Endoscopy, Alimentary Pharmacology and Therapeutics, Digestive Endoscopy, Journal of Gastroenterology, Helicobacter, and Gastric Cancer) in 2000, 2005, 2010, 2015, and 2020. These original articles were classified according to the gender and nationality of the first and senior (last listed) authors. Linear-by-linear association test was used to analyze the proportion of women authors over time. Multivariable logistic regression was applied to explain the factors impacting authorship difference of first and senior authors. A total of 561 original articles on H. pylori were collected for this study, accounting for 10.70% in 2000 to 7.60% in 2020 among all articles. In these original articles, the percentage of women first authors increased from 14.60% in 2000 to 45.0% in 2020 (P < .001). The percentage of women senior authors increased from 5.60% in 2000 to 18.80% in 2020 (P < .001). Women first authors were more likely to perform research with women senior authors (18.42%) than with men senior authors (10.23%, P < .001). The proportion of women first authors from Oceania were higher than that from North and South America (P = .004), whereas there was no statistical difference regarding women senior authors. In the past 2 decades, although the percentage of women authors among both first and senior authors in the field of H. pylori research has increased significantly, women are still a minority in original research.

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Section: Author Association By Gendermentioning

confidence: 99%

Trends in gender disparity in the field of Helicobacter pylori research from 2000 to 2020: A cross-sectional study

Shi,

Huang,

Tan

et al. 2023

Medicine

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“…In conclusion, there is an overrepresentation of high-risk procedures among male-surgeon procedures, up to a factor of 2.41 for orthopedic procedures, with multiple independent variables not being balanced between the groups, invalidating the conclusions by Wallis et al…”

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confidence: 99%

Examining Gender Disparities Among Physicians When Sample Sizes Differ

Rehm,

Hatzantoni,

Sheharyar

2024

JAMA Surg

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To the Editor We read with interest the recent publication by Wallis and colleagues. 1 There are several mismatches between the male-female groups, which support that the reported outcome differences in mortality, readmission, and complication rate might be the result of male surgeons having performed more complex surgeries (high complexity: male surgeons = 65.7%; female surgeons = 59.5%) on older patients (mean patient age: male surgeons = 60 years; female surgeon = 52.5 years) with more serious medical problems (comorbidity aggregate disease group ≥11: male surgeons = 20.3%; female surgeons = 17.7%).Wallis et al 1 included 12.2 times more male than female orthopedic surgeons who performed 29.5 times the number of surgeries, creating an overrepresentation in the male cohort of patients with femoral fracture, who are associated with a high complication rate. Haugan et al 2 reported a 90-day and 1-year mortality rate of 13.8% and 25.9%, respectively, and a 90-day and 1-year readmission rate of 23.7% and 39.8%, respectively, after hip fracture surgery.Boukebous et al 3 reported that 77% of patients with hip fracture were female, which possibly explains why Wallis et al 1 identified that female emergent cases had significantly higher rates of adverse postoperative events when treated by male surgeons, because of the overrepresentation and high mortality and readmission rate of femoral fracture patients, rather than being linked to the sex of the surgeon.Wallis et al 1 included 15.8 times more male than female neurosurgeons, but male neurosurgeons performed 19.6 times the number of surgeries. This imbalance creates further bias against male surgeons, considering the high surgical mortality rate for nonelective surgeries and high readmission rates in this specialty. Donoho et al 4 reported 30-and 90-day readmission rates after craniotomy for malignant brain tumors of 13.2% and 25.7%, respectively, excluding planned readmissions for chemotherapy. Wallis et al 1 did not identify how many of the readmissions were planned and not due to an adverse event.

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“…In Reply We read with interest the letters from Manoj and Singh and from Rehm and colleagues regarding our recent work . It is clear from responses to this study, as well as previous publications, that this is a topic of great interest not just among surgeons but across the profession of medicine and indeed more broadly in society.…”

mentioning

confidence: 99%

Examining Gender Disparities Among Physicians When Sample Sizes Differ—Reply

Wallis,

Jerath,

Satkunasivam

2024

JAMA Surg

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COMMENT & RESPONSEIn Reply We read with interest the letters from Manoj and Singh and from Rehm and colleagues regarding our recent work. 1 It is clear from responses to this study, as well as previous publications, 2 that this is a topic of great interest not just among surgeons but across the profession of medicine and indeed more broadly in society. Many of the comments arising in regards to this article bear similarities to those relating to prior publications that we have addressed previously. 3 We want to emphasize a point made obliquely by both Manoj and Singh and Rehm and colleagues: women are underrepresented in surgery. Almost certainly as a causative factor, and potentially as a result, women in surgery face many training and professional challenges 4 that are not shared by their male colleagues. However, we would not expect that a lower number of women in surgery would lead to disproportionately lower complication rates as suggested by Manoj and Singh.A number of methodologic considerations bear comment. First, in our analysis, we explicitly accounted for fixed procedure-level effects using procedural fee codes. This should abate concerns of Rehm et al regarding differential case mix between male and female surgeons.Before doing so, it is worth reiterating the nature of the dataset; using health administrative data in Ontario, Canada, we are able to capture all interactions between patients and the health care system, including surgical procedures, hospitalizations, emergency department visits, and outpatient care, in addition to capturing patient-and physician-level information in rich detail. This has a number of important implications. First, the use of data from a single-payer health care system provides a comprehensive dataset. Second, the rich data included allow for detailed data regarding patients' acute and chronic health information, health care utilization, and outcomes. While all observational studies are affected by residual confounding, the granularity of data available here exceeds that of other datasets, such as Medicare.Rehm and colleagues note that male surgeons performed a greater proportion of cases in orthopedic and neurosurgery than would be anticipated given the proportion of male surgeons in these subspecialties. Indeed, this reflects data that male surgeons were more likely to be high volume. Given that surgical volume is typically associated with improved patient outcomes, 5 it is our view that residual confounding on account of volume should favor male, not female, surgeons. These authors further note that patients treated by male surgeons were somewhat older and had more comorbidities; this is true and reflects in part differences in the surgical specialties of male and female surgeons. Thus, not only did we account for this in multivariable regression models in keeping with standard methods for case-mix risk adjustment, but we also further accounted for this in our analysis, which used procedure-specific fixed effects.We encourage our colleagues to be open and inquisiti...

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

Cited by 96 publications

References 22 publications

Trends in gender disparity in the field of Helicobacter pylori research from 2000 to 2020: A cross-sectional study

Trends in gender disparity in the field of Helicobacter pylori research from 2000 to 2020: A cross-sectional study

Examining Gender Disparities Among Physicians When Sample Sizes Differ

Examining Gender Disparities Among Physicians When Sample Sizes Differ—Reply

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