Study finds small differences in patient outcomes between male and female surgeons

October 10, 2017, British Medical Journal

Patients treated by female surgeons have slightly lower death rates in the first few weeks after their operation than patients treated by male surgeons, finds a study from Canada published by The BMJ today.

However, the study cannot establish cause and effect, and the researchers stress that their results "do not support the preferential selection of a surgeon of either sex in clinical practice."

Studies have shown that women and men practise medicine differently, although little research exists on differences in learning styles, acquisition of skills, or outcomes for female and male surgeons.

Given that surgery is a traditionally male-dominated profession, a team led by Houston Methodist surgeon and researcher, Raj Satkunasivam, who was at the University of Toronto when the study was completed, wanted to examine the effect of surgeon sex on postoperative outcomes of patients undergoing common surgical procedures.

They compared outcomes for patients undergoing one of 25 surgical procedures by a female surgeon with patients undergoing the same operation by a male surgeon of the same age in the same hospital in Ontario, Canada.

To ensure the two groups were well balanced, patients were matched for age, sex, presence of other conditions and income. Surgeons were matched for age, experience, volume (number of operations performed in the last year) and hospital.

The main outcome was a combined measure of death, readmission to hospital and complications 30 days after surgery.

A total of 104,630 patients were treated by 3,314 surgeons (774 female and 2,540 male) over the study period (2007-2015). The researchers found that patients treated by female surgeons were slightly less likely to die within 30 days, but there was no significant difference in readmissions or complications.

There was also no difference in outcomes by surgeon sex in patients who had emergency surgery, where patients do not usually choose their surgeon. And results remained largely unchanged after accounting for additional factors like case mix (differences in a patient's condition).

Possible reasons underlying better outcomes for patients treated by female surgeons are not clear, say the authors, although it may be related to delivery of care that is more in line with guidelines, more patient centred, and involves better communication.

The authors stress that this is an observational study, so no firm conclusions can be drawn about cause and effect, and they cannot rule out the possibility that the lower mortality associated with female surgeons may be due to other unmeasured factors.

Nevertheless, they say their 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."

"Our findings have important implications for supporting sex equality and diversity in a traditionally male dominated profession," they conclude.

In a linked editorial, Clare Marx and Derek Alderson of the Royal College of Surgeons of England argue that, while this study confirms the safety, skill, and expertise of women surgeons relative to their male colleagues, the sex of the surgeon is unlikely to be relevant.

Improving is a complex undertaking, they say. Surgeons and researchers tend to focus on physical and clinical end points, often failing to acknowledge the importance of longer term outcomes that matter most to patients, while hospital providers "are more concerned with cost-effectiveness and efficiency savings, than community costs."

With so many critical issues to consider, trying to find out why there is a very small difference in short term clinical outcomes between male and female surgeons, "is unlikely to prove worthwhile," they argue. "Nor are we convinced that the sex of the surgeon will emerge as an important determinant of a good outcome for having surgery," they conclude.

Explore further: Surgeon volume impacts parathyroidectomy outcomes

More information: Comparison of postoperative outcomes among patients treated by male and female surgeons: a population based matched cohort study, www.bmj.com/content/359/bmj.j4366

Editorial: Improving patient outcomes after surgery, www.bmj.com/content/359/bmj.j4580

Related Stories

Surgeon volume impacts parathyroidectomy outcomes

April 22, 2017
(HealthDay)—Patients undergoing parathyroidectomy by high-volume surgeons have a lower rate of vocal cord paralysis compared to patients of low-volume surgeons, according to a study published online April 20 in JAMA Otolaryngology-Head ...

Study of thousands of operations finds overlapping surgeries are safe for patients

December 1, 2016
A common way of scheduling surgeries to expand patient access to care and improve hospital efficiency, known as "overlapping surgeries," is as safe and provides the same outcomes for patients as non-overlapping surgeries, ...

The gender divide in urology: Surgeon gender shapes the clinical landscape

August 17, 2016
Although female certified urologists are still a minority within the specialty, they perform many more procedures on women than their male colleagues, who perform more procedures on men than their female colleagues. As more ...

Study: Higher costs for complex cancer surgery indicator for worse care

April 25, 2017
Higher costs for complex cancer surgery may be an indicator for worse—rather than better—quality of care, according to new research by experts at Rice University and the University of Texas MD Anderson Cancer Center. ...

Study examines association between surgical skill and long-term outcomes of bariatric surgery

April 13, 2016
In contrast to its effect on early complications, surgical skill did not affect postoperative weight loss or resolution of medical conditions at 1 year after laparoscopic gastric bypass, according to a study published online ...

Surgeon experience affects complication rate of spinal stenosis surgery

June 7, 2012
For patients undergoing surgery for spinal stenosis, the risk of complications is higher when the surgeon performs very few such procedures—less than four per year, suggests a study in the June issue of Neurosurgery, ...

Recommended for you

3-D-printed tracheal splints used in groundbreaking pediatric surgery

September 19, 2018
Children's Healthcare of Atlanta has performed Georgia's first-ever procedure to place 3-D-printed tracheal splints in a pediatric patient. A cross-functional team of Children's surgeons used three custom-made splints, which ...

Muscle relaxants increase risk of respiratory complications

September 18, 2018
Muscle relaxants are a necessary part of anesthesia during certain major operations. However, studies have hinted at respiratory risks connected with these drugs. POPULAR, a major prospective observational European study ...

Gunshot victims require much more blood and are more likely to die than other trauma patients

September 17, 2018
In a new analysis of data submitted to Maryland's state trauma registry from 2005 to 2017, Johns Hopkins Medicine researchers found that gunshot victims are approximately five times more likely to require blood transfusions, ...

Liver allocation system disadvantages children awaiting transplants

September 17, 2018
Children are at a considerable disadvantage when competing with adults for livers from deceased organ donors in the U.S. allocation system, a University of Pittsburgh Graduate School of Public Health-led analysis reveals ...

Taste preferences connected to success of long-term weight loss after bariatric surgery

September 16, 2018
Following Roux-en-Y gastric bypass (RYGB), a type of bariatric surgery, many patients exhibit a reduction in taste preference for sweet and fatty foods, although this effect may only be temporary, according to new research ...

New insights into what drives organ transplant rejection

September 6, 2018
When it comes to transplant rejection, some organs are far trickier than others. Some transplantable organs, such as the liver, are readily accepted by the recipient's immune system, rarely triggering an immune response and ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.