Poor outcome more likely when patient is female, surgeon is male: study

You can't always choose who operates on you, especially in an emergency, but the sex of your surgeon shouldn't matter, should it?

It just may, according to a Canadian study of 1.3 million people.

It reported that women who underwent common elective or emergency surgeries with male surgeons had a 15% higher chance of dying, experiencing a major complication, and/or being readmitted to the hospital within 30 days than they did if a woman performed their surgery.

In contrast, men experience similarly good outcomes regardless of their surgeon's sex, the study showed.

Exactly why such "sex discordance" exists is not fully understood yet, and the study wasn't designed to answer this question.

"We hypothesize, based on prior work regarding communication between patients and physicians, that this may underpin the observation," said study author Dr. Christopher Wallis, an assistant professor of urology at the Mount Sinai Hospital and University Health Network in Toronto.

Previous studies have shown that female doctors tend to listen more, and their patients may fare better as a result.

"Patients should seek to find surgeons that they trust and communicate well with," Wallis said. "As a surgical community, we should seek to better understand the factors underpinning these observations such that we can understand the processes of care that lead to optimal outcomes so all surgeons can use these and all patients can benefit."

The study included more than 1.3 million patients who had 21 common elective and emergency surgeries between 2007 and 2019. Of these, close to 15% experienced one or more bad outcomes in the month after surgery including death, readmission, and/or a complication. Nearly 46% of patients were the same sex as their surgeon.

Female patients treated by male surgeons fared worse after surgery, but female surgeons experienced similarly good outcomes whether they operated on men or women, the study showed.

The research took place in Canada, but the findings are likely generalizable to the United States, Wallis said.

The findings were published online Dec. 8 in JAMA Surgery.

"This study provides new information about the role of sex differences between surgeons and patients and the potential relationship with outcomes by showing that sex discordance does affect outcomes," said Dr. Amalia Cochran, who cowrote a commentary that accompanied the findings.

There simply aren't as many female surgeons as male ones, said Cochran, a professor of surgery at the University of Florida College of Medicine.

While there's finally sex equality in medical school, it's not yet showing up in surgical ranks: Women made up just 22% of U.S. general surgeons in 2019, the editorial noted.

Women should not be at a disadvantage just because of these numbers, and the study is "yet another reason why as a profession we must be intentional about having a workforce that is representative of the patients we care for and in which we foster belonging for all workforce members," Cochran said.

Dr. Cassandra Kelleher, a pediatric surgeon at Massachusetts General Hospital in Boston, said the findings probably don't relate to differences in surgical prowess or technical skill between male and female surgeons.

"It's likely due to something more nuanced such as how surgeons listen to people after surgery and the way that they involve family or caregivers, or listen to nurses on the floor who express concern," said Kelleher, who was not involved in the new study.

Other factors may play a role, too, including how approachable the surgeon is and the level of risk he or she is willing to assume.

The patient-surgeon relationship is extremely important.

"It may be that a woman has a really good rapport with a male doctor, and that is much more important than gender," Kelleher said. "All surgeons should place more weight on communication, listening skills and risk assessment to help close these gaps in care."

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