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. 2023 Nov 1;158(11):1185-1194.
doi: 10.1001/jamasurg.2023.3744.

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

Christopher J D Wallis  1   2   3 , Angela Jerath  4 , Khatereh Aminoltejari  1 , Kirusanthy Kaneshwaran  4 , Arghavan Salles  5 , Natalie Coburn  6 , Frances C Wright  6 , Lesley Gotlib Conn  6 , Zachary Klaassen  7 , Amy N Luckenbaugh  8 , Sanjana Ranganathan  9 , Carlos Riveros  9 , Colin McCartney  4 , Kathleen Armstrong  9 , Barbara Bass  10 , Allan S Detsky  11   12   13 , Raj Satkunasivam  14   15   16
Affiliations

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

Christopher J D Wallis et al. JAMA Surg. .

Abstract

Importance: Sex- and gender-based differences in a surgeon's medical practice and communication may be factors in patients' perioperative outcomes. Patients treated by female surgeons have improved 30-day outcomes. However, whether these outcomes persist over longer follow-up has not been assessed.

Objective: To examine whether surgeon sex is associated with 90-day and 1-year outcomes among patients undergoing common surgeries.

Design, setting, and participants: A population-based retrospective cohort study was conducted in adults in Ontario, Canada, undergoing 1 of 25 common elective or emergent surgeries between January 1, 2007, and December 31, 2019. Analysis was performed between July 15 and October 20, 2022.

Exposure: Surgeon sex.

Main outcomes and measures: An adverse postoperative event, defined as the composite of death, readmission, or complication, was assessed at 90 days and 1 year following surgery. Secondarily, each of these outcomes was assessed individually. Outcomes were compared between patients treated by female and male surgeons using generalized estimating equations with clustering at the level of the surgical procedure, accounting for patient-, procedure-, surgeon-, anesthesiologist-, and facility-level covariates.

Results: Among 1 165 711 included patients, 151 054 were treated by a female and 1 014 657 by a male surgeon. Overall, 14.3% of the patients had 1 or more adverse postoperative outcomes at 90 days and 25.0% had 1 or more adverse postoperative outcomes 1 year following surgery. Among these, 2.0% of patients died within 90 days and 4.3% died within 1 year. Multivariable-adjusted rates of the composite end point were higher among patients treated by male than female surgeons at both 90 days (13.9% vs 12.5%; adjusted odds ratio [AOR], 1.08; 95% CI, 1.03-1.13) and 1 year (25.0% vs 20.7%; AOR, 1.06; 95% CI, 1.01-1.12). Similar patterns were observed for mortality at 90 days (0.8% vs 0.5%; AOR 1.25; 95% CI, 1.12-1.39) and 1 year (2.4% vs 1.6%; AOR, 1.24; 95% CI, 1.13-1.36).

Conclusions and relevance: After accounting for patient, procedure, surgeon, anesthesiologist, and hospital characteristics, the findings of this cohort study suggest that patients treated by female surgeons have lower rates of adverse postoperative outcomes including death at 90 days and 1 year after surgery compared with those treated by male surgeons. These findings further support differences in patient outcomes based on physician sex that warrant deeper study regarding underlying causes and potential solutions.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Jerath reported receiving grant support from a merit award, Department of Anesthesiology and Pain Medicine, University of Toronto, Data Science Institute, University of Toronto, Women’s Heart and Brain Award, Heart and Stroke Foundation of Canada and Health Canada. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Cohort Derivation
Figure 2.
Figure 2.. Subgroup Analysis Assessing the Association Between Surgeon Sex and Composited Adverse Postoperative Outcomes
ADG indicates aggregate disease group; AOR, adjusted odds ratio.
See this image and copyright information in PMC

References

    1. Wallis CJD, Jerath A, Coburn N, et al. . Association of surgeon-patient sex concordance with postoperative outcomes. JAMA Surg. 2022;157(2):146-156. doi:10.1001/jamasurg.2021.6339 - DOI - PMC - PubMed
    1. Wallis CJD, Jerath A, Kaneshwaran K, et al. . Association between surgeon and anesthesiologist sex discordance and postoperative outcomes: a population-based cohort study. Ann Surg. 2022;276(1):81-87. doi:10.1097/SLA.0000000000005495 - DOI - PubMed
    1. Wallis CJ, Ravi B, Coburn N, Nam RK, Detsky AS, Satkunasivam R. Comparison of postoperative outcomes among patients treated by male and female surgeons: a population based matched cohort study. BMJ. 2017;359:j4366. doi:10.1136/bmj.j4366 - DOI - PMC - PubMed
    1. Satkunasivam R, Klaassen Z, Ravi B, et al. . Relation between surgeon age and postoperative outcomes: a population-based cohort study. CMAJ. 2020;192(15):E385-E392. doi:10.1503/cmaj.190820 - DOI - PMC - PubMed
    1. Tsugawa Y, Jena AB, Figueroa JF, Orav EJ, Blumenthal DM, Jha AK. Comparison of hospital mortality and readmission rates for Medicare patients treated by male vs female physicians. JAMA Intern Med. 2017;177(2):206-213. doi:10.1001/jamainternmed.2016.7875 - DOI - PMC - PubMed

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