30 Aug Surgery: Post-Op Outcomes Differ by Gender of Surgeon
MedicalResearch.com Interview with:
Christopher Wallis, MD, PhD
Assistant Professor of Urology
Department of Surgery
University of Toronto and Urologic Oncologist
Mount Sinai Hospital
MedicalResearch.com: Could you give a little context – what was the question you were looking at?
- We have been studying how the primary treating surgeons sociocultural characteristics impact the recovery of patients they are looking after.
- Specifically, we have been studying the effect of surgeon sex on outcomes such as death, complications and readmission after common and complex surgeries. These are outcomes that are important to patients and the health system.
- Previously, we showed that patients with a female surgeon had better short term (30 day) outcomes than similar patients having surgery with a man. This study asked the question of whether the sex of a patient’s surgeon affects patients’ longer term outcomes at 90 days and 1 year, after surgery.
MedicalResearch.com: What operations are included in your cohort?
- We have included 25 different surgical procedures across the breadth of surgical subspecialties including general surgery, thoracic surgery, hepatobiliary surgery, bariatric surgery, cardiac surgery, neurosurgery, orthopedic surgery, otolaryngology/ENT, gynecology, urology, plastic surgery, and vascular surgery.
MedicalResearch.com: Can you say something about the kinds of post-operative issues patients might face, the sort you counted?
- As our primary study outcome, we looked at a so-called composite outcome which combines death, the need for a re-operation to address complications from the original surgery, need for re-admission to hospital to address complications from the original surgery, and major medical complications including heart attack, stroke, blood clots, kidney failure, major infection, and the like.
- The secondary outcomes study the effect of surgeon sex on each of these components (i.e., death, readmission, complications) individually.
MedicalResearch.com: I want to be sure I’ve understood the findings correctly – what numbers are you happy with journalists using when we write about the medical complications that patients faced when they were seen by male vs female surgeons at 90 days and 12 months?
- It’s important to consider both relative and absolute differences. Importantly, all of these numbers are so-called risk adjusted in that we accounted for factors that could impact the study outcomes such as differences in patients age, overall health (comorbidity), type of surgery, volume of cases, surgical experience and the like.
- Looking at that primary composite outcome, patients treated by a male surgeon were 8% more likely to have an adverse post-operative event at 90 days and 6% more likely to have such an event at 1 year after surgery (see Table 2, Row 1).
This corresponds to an absolute increase in risk of 1.4% (from 12.5% to 13.9%) at 90 days and 4.3% (from 20.7% to 25.0%) at 1 year.
MedicalResearch.com: Did you see a difference in deaths too?
- A similar, and actually larger, effect was seen for mortality. Again, using these risk- adjusted models to account for differences in patient factors, surgeon factors, hospital factors, and procedural factors, patients treated by male surgeons were 25% and 24% more likely to die at 90 days and 1 year after surgery than those treated by female surgeons. There was a 25% and 24% increased risk of death at 90 days and 1 year respectively.
MedicalResearch.com: What do you think might explain the difference?
- This study cannot provide a specific answer to why these differences are occurring. As a result, we have to postulate. It has been known for some time that male and female physicians differ in how they practice medicine. This includes things like the amount of time they spend with patients, their communication approach, and guideline adherence. These factors may be contributing – we are currently undertaking more work to better understand this.
- Its important to also think about things that are unlikely to be contributory. Given the size of the study and similar training pathways, we do not think there are technical differences between male and female surgeons. Rather, we are hypothesizing there may be differences in how physicians practice, make decisions and consult with patients.
MedicalResearch.com: Do you think there are lessons here for medicine?
Response: I think there are numerous lessons here. As a male surgeon, I think these data should cause me and my colleagues to pause and consider why this may be. As alluded to above, men and women differ in how they practice medicine – embracing or adopting some practices that are more common among female physicians is likely to improve outcomes for my patients. Since undertaking this work, I have certainly done this personally and would encourage my colleagues to do the same – use this as a moment for introspection.
More broadly, these data hopefully provide the impetus for further efforts to make surgery (and medicine more broadly) a field that is welcoming to women. Beyond attracting women to the field, we need to evolve such that surgery, as a field, is able to retain women and promote them to positions of influence – currently, there is a wealth of data that we have a so-called leaky pipeline with diminishing numbers of women in senior positions.
Finally, this work should prompt further research to understand the underlying causes of these differences in outcomes such that all physicians may improve the care they deliver to patients.
Wallis CJDJerath A Aminoltejari K, et al. Surgeon Sex and Long-Term Postoperative Outcomes Among Patients Undergoing Common Surgeries. JAMA Surg. Published online August 30, 2023. doi:10.1001/jamasurg.2023.3744
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