SLR - October 2023 - McElroy
Title: Surgeon Sex and Long-Term Postoperative Outcomes Among Patients Undergoing Common SurgeriesReference: Wallis CJD, Jerath A, Aminoltejari K, Kaneshwaran K, Salles A, Coburn N, Wright FC, Gotlib Conn L, Klaassen Z, Luckenbaugh AN, Ranganathan S, Riveros C, McCartney C, Armstrong K, Bass B, Detsky AS, Satkunasivam R. Surgeon Sex and Long-Term Postoperative Outcomes Among Patients Undergoing Common Surgeries. JAMA Surg. 2023 Aug 30:e233744. doi: 10.1001/jamasurg.2023.3744. Epub ahead of print. PMID: 37647075; PMCID: PMC10469289.
Level of Evidence: Level III
Reviewed By: Tara McElroy, DPM, MPH
Residency Program: Inova Fairfax Medical Campus, Falls Church, VA
Podiatric Relevance: While the number of female podiatric physicians has steadily increased, there is still a large gender gap, most notably in foot and ankle surgery. There differences between female and male providers have been found to include differences in communication, practice style, physician-patient relationships, and patient selection. While a previous observational study has shown that patients treated by female surgeons experienced lower negative postoperative outcomes (re-admission, morality, and complications) at thirty days, this may not be predictive of long term outcomes. Thus, the purpose of this study was to examine the association between surgeon's gender and patients’ long term postoperative outcomes between 90 days and 1 year for common surgeries.
Methods: A retrospective cohort study of 1165711 adult patients undergoing common surgeries was conducted out of Canada from January 2007 to December 2019. Adverse outcomes included death, readmission, and complications, which were compared using estimating equations with clustersting the surgical procedure, surgeon, anesthesiologist, and facility level covariates. Orthopedic surgery encompassed a large portion of the patient population, with 33.6% of surgical cases being orthopedic in nature.
Results: 151054 patients were treated by female surgeons and 1014657 were treated by male surgeons. The overall adverse outcomes at 90 days was 14.3% (2.0% deaths, 8.1% re-admitted, 6.6% major complications) compared to 25% (4.3% deaths, 18.9% readmitted, 7.9% major complications) at 1 year. At 90 days, patients treated by female surgeons were less likely to have adverse outcomes (13.9% treated by male surgeons vs 12.5% treated by female surgeons). Similarly, at 1 year patients treated by female surgeons were less likely to have adverse outcomes (25.0% treated by male surgeons vs 20.7% treated by female surgeons). This association was observed across each of the secondary end points at 90 days and 1 year.
Conclusion: Overall, patients undergoing surgery with female surgeons were less likely to experience adverse outcomes in 90 days to 1 year after surgery. As seen in previous studies, this may be due to different communication and practice styles, with the possibility that female surgeons are more likely to discuss long term postoperative courses more effectively with patients. Despite multiple studies indicating that patients treated by female surgeons are less likely to experience short and long term adverse outcomes, there is still a significant gender gap. Specifically in podiatric surgery, females have been found to spend less time in the operating room and more time in a clinical setting when compared to male counterparts. Additionally female podiatric surgeons are less likely to be board certified. Thus, it is essential to continue to recruit diverse podiatric applicants and improve female physician retention, specifically within surgical subspecialities, to improve long term patient outcomes.