Study: Patients treated by female surgeons experience better postoperative outcomes

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"Patients who have a female surgeon are about 25% less likely to die than if they had a male surgeon," says Christopher J.D. Wallis, MD, PhD.

In this video, Christopher J.D. Wallis, MD, PhD, highlights the background and findings from the study, “Surgeon sex and long-term postoperative outcomes among patients undergoing common surgeries,” for which he served as the lead author. Wallis is a urologic oncologist at Mount Sinai Hospital and University Health Network and an assistant professor of surgery at the University of Toronto in Toronto, Ontario, Canada.

Video Transcript:

This is the latest in a line of work that we've been doing, dating back to about 2017 or so. That began with a paper we published in The BMJ looking at the effect of surgeon sex on short-term patient outcomes, finding that patients who had a female surgeon had lower rates of 30-day death, readmission, reoperation, and major medical complications. That was the first data that showed there was an effect of surgeon sex on patients' surgical outcomes. Subsequent studies have followed that up and corroborated our findings, adding some nuance to suggest that mostly these effects are observed when patients undergo elective surgeries, and the effects are less pronounced in the emergency surgery operative setting.

Now, this is all built on the context of research that began about 20 years ago, showing that men and women differ in how they practice medicine. I think it's fairly well known and well accepted that female physicians spend more time with their patients, maybe a little less appreciated is that there's differences in communication styles that may be important. Female physicians are more likely to get more information from their patients, not just biomedical information, but also psychosocial information to really understand the context of the patient's situation. And perhaps most importantly, it's been studied in primary care, patients who have a female physician are more likely to get guideline concordant care. So, what does that mean in the context of primary care? It means patients are more likely to get their cancer screening tests, have their lipids checked appropriately, have their hemoglobin A1C tested. So, all those process metrics suggests that female physicians are providing really high-quality care and arguably higher quality of care. What we showed in the data leading up to this is that that may translate to better surgical outcomes.

So, this paper takes a leap from the 30-day outcome, which is the standard surgical metric, to 90 days and 1 year. I think that's important. I'm an oncologist; I do cystectomies and other major operations. It's very clear that the recovery process from surgery is not done at 30 days. There are lingering effects of surgery that take much longer. Things that surgeons can do in and around the time of surgery may have lasting effects. Importantly, Dr. [John] Birkmeyer’s group in Michigan showed that while surgeons’ skill rated by other surgeons affects 30-day outcomes, importantly, for bariatric surgery, it has less of an important effect on 1-year outcomes. So, it remained an open question whether surgeon sex would contribute to these longer-term outcomes, or if other factors would take over.

What we showed is that the results are very consistent at 90 days and at 1 year. Patients who have a female surgeon are about 25% less likely to die than if they had a male surgeon. When we put together our composite end point–which we called major adverse events, which was death, readmission, reoperation, or a major medical complication like venous thrombotic event, major infection, MI, stroke, need for intubation–there's about a 5% to 6% difference with lower rates observed with the patients who had a female surgeon.

It's important to consider the context of the study. We included 25 different common surgeries, and we tried to be inclusive of all surgical subspecialties from cardiac to orthopedics, general surgery, obstetrics and gynecology, urology, vascular surgery, plastics. So, I would say one of the most remarkable things about our finding is the consistency of findings. Whether you looked across surgical subspecialties, whether you looked at different groups of surgeons based on their age or their years of practice or their surgical volume, whether you looked at patients who are male or female or older or younger, or sicker or healthier, whether you looked at academic hospitals or community hospitals, across all these different subgroups, we saw a consistent effect where reliably, the patients who had a female surgeon were doing better.

This transcription has been edited for clarity.

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