Comparison of Postoperative Outcomes Among Patients Treated by Male Versus Female Surgeons: A Systematic Review and Meta-analysis

Abstract

Objective: To compare clinical outcomes of patients treated by female surgeons versus those treated by male surgeons.

Background: It remains unclear as to whether surgical performance and outcomes differ between female and male surgeons.

Methods: We conducted a meta-analysis to compare patients' clinical outcomes-including patients' postoperative mortality, readmission, and complication rates-between female versus male surgeons. MEDLINE, Embase, CENTRAL, ICTRP, and ClinicalTrials.gov were searched from inception to September 8, 2022. The update search was conducted on July 19, 2023. We used random-effects models to synthesize data and GRADE to evaluate the certainty.

Results: A total of 15 retrospective cohort studies provided data on 5,448,121 participants. We found that patients treated by female surgeons experienced a lower postoperative mortality compared with patients treated by male surgeons [8 studies; adjusted odds ratio (aOR), 0.93; 95% CI, 0.88-0.97; I2 =27%; moderate certainty of the evidence]. We found a similar pattern for both elective and nonelective (emergent or urgent) surgeries, although the difference was larger for elective surgeries (test for subgroup difference P =0.003). We found no evidence that female and male surgeons differed for patient readmission (3 studies; aOR, 1.20; 95% CI, 0.83-1.74; I2 =92%; very low certainty of the evidence) or complication rates (8 studies; aOR, 0.94; 95% CI, 0.88-1.01; I2 =38%; very low certainty of the evidence).

Conclusion: This systematic review and meta-analysis suggests that patients treated by female surgeons have a lower mortality compared with those treated by male surgeons.

FIGURE 1

Literature search flow diagram.

FIGURE 2

Pooled estimates in postoperative mortality. Effect size was determined using the random-effects model weighted by the inverse of the variance estimate. Squares represent effect size, with marker size reflecting the statistical weight of the study, obtained using random-effects meta-analysis; diamond represents the overall odds ratios and 95% CI.

FIGURE 3

Pooled estimates in postoperative readmission rate and complication rate. A, Postoperative readmission rate. B, Complication rate. Effect size was determined using the random-effects model weighted by the inverse of the variance estimate. Squares represent effect size, with marker size reflecting the statistical weight of the study, obtained using random-effects meta-analysis; diamonds represent the overall odds ratios and 95% CI.