Study explores association between surgical outcomes, patients’ gender and the gender of their surgeons

New research from scientists at Sunnybrook, the University Health Network and the University of Toronto calls into question whether your surgeon’s gender could impact your outcomes after surgery.

The study, recently published in JAMA Surgery, examined 1.3 million patients treated by nearly 3,000 surgeons between 2007 and 2019 in Ontario, measuring adverse postoperative outcomes such as death, readmission and complications 30 days after surgery. The researchers analyzed associations between surgeon-patient gender concordance (male surgeon with male patient, female surgeon with female patient) or discordance (male surgeon with female patient, female surgeon with male patient). They looked at the results after 21 different procedures in various surgical specialties.

“Previous research in the emergency care setting has shown that gender discordance, particularly among male physicians and female patients, may be associated with certain adverse effects,” says Dr Angela Jerath, one of the study co-authors and an anesthesiologist and scientist at Sunnybrook. “We wanted to know if this was also the case with regard to surgical results.”

Researchers found that female patients were 15% more likely to experience adverse effects from common surgical procedures when treated by a male rather than a female surgeon. When a male surgeon operated on a female patient – ​​compared to a female surgeon – there was a 32% increase in the likelihood of a patient dying within 30 days of the procedure. In contrast, for male patients, there was no difference in outcomes depending on whether they were treated by female surgeons or male surgeons.

Dr. Angela Jerath, study co-author and anesthetist and scientist at Sunnybrook Health Sciences Center.

“These results are concerning because the gender of patients and surgeons should not lead to differences in patient outcomes after surgery,” says Dr. Jerath. “As an anesthesiologist, I know that there are many excellent male surgeons who consistently achieve good results. However, at the population level, the analysis points to a concerning difference between male and female surgeons overall. and its impact on patient outcomes, which needs to be explored.

The researchers say more work is needed to determine the cause of the disparities. Dr Christopher Wallis, who co-led the study, says the results are unlikely to be the result of technical difficulties between the sexes. “The surgeons, men and women, follow the same technical medical training. The very large sample size and examination of many different surgical specialties would have mitigated the technical differences between male and female surgeons. We believe there are other complex factors at play,” says Dr. Wallis, a urological oncologist in the Division of Urology at Mount Sinai Hospital and the University Health Network.

The authors propose implicit gender biases, different communication or interpersonal skills that may influence trust, and variations in decision-making and clinical judgment as potential factors contributing to the disparities.

“Previous research has also shown that symptoms reported by female patients may be underestimated in healthcare settings (especially among male physicians). Thus, early symptoms of complications may go unnoticed when they can be mitigated and instead manifest as more serious events,” says Dr. Wallis.

The researchers add that the study highlights the need to diversify the workforce to better serve the patients they treat. “This work really highlights the importance of changing the culture of medicine to promote the role of women in our field,” says Dr. Wallis.

Although more research is needed, the authors say their advice to patients is to make sure they have a good, trusting relationship with their surgeon, regardless of gender. “The patient-surgeon relationship is extremely important,” says Dr. Jerath. “Patients want to be sure they can openly discuss their questions and concerns before, during and after surgery.”

Read more about research in The Guardian, US News and CTV News.

Paul N. Strickland