Women Are 32% More Likely To Die After Surgery By A Surgeon, Study Finds | Doctors

Women who are operated on by a male surgeon are much more likely to die, experience complications and be readmitted to the hospital than when a woman performs the procedure, research reveals.

Women are 15% more likely to have a poor outcome and 32% more likely to die when a man performs the surgery rather than a woman, according to a study of 1.3 million patients.

The findings have sparked a debate over the fact that surgery in the UK remains a hugely male-dominated area of ​​medicine and claims that “implicit sexual biases” among male surgeons may help explain why women they are at greater risk when undergoing surgery.

“In our 1.3 million patient sample that included nearly 3,000 surgeons, we found that patients treated by male surgeons were 15% more likely to have worse outcomes than patients treated by surgeons,” said Dr. Angela Jerath , an associate professor and clinical epidemiologist at the University of Toronto in Canada and a co-author of the findings.

“This result has real-world medical consequences for patients and manifests itself in more complications, hospital readmissions and death for women compared to men.

“We have shown in our article that we are failing some patients and some are forgetting unnecessarily with adverse and sometimes fatal consequences.”

The findings have been published in the medical journal JAMA Surgery.

Jerath added: “These results are concerning because there should be no sex difference in patient outcomes, regardless of the sex of the surgeon.

“At the macro level, the results are worrying. When a surgeon operates, patient outcomes are generally better, particularly for women, even after adjusting for differences in chronic health status, age, and other factors, when undergoing the same procedures.

Jerath and his colleagues analyzed the records of 1,320,108 patients in Ontario who underwent 21 common surgical procedures performed by 2,937 surgeons between 2007 and 2019. They range from hip and knee replacements and weight-loss surgery to removal of an appendix. or gallbladder and more complicated operations. such as a heart bypass, aneurysm repair, and brain surgery.

For each of the 1.3 million operations they analyzed, the sex of each patient and details of how their procedure had gone, as well as the sex of the surgeon who performed it.

They found that men who had an operation had the same results regardless of whether their surgeon was male or female. However, women experienced better results if the procedure was performed by a surgeon compared to a male surgeon. There were no gender differences in how the surgery was for men or women operated by a female surgeon.

Jerath added that while “there are some excellent male surgeons who always do well, what is concerning is that this analysis points to some real difference between male and female surgeons in general, where practice can affect overall patient outcomes.” .

The researchers said the study was the first of its kind to examine the association between the sex of the patient, the sex of the surgeon, and the results of surgery. They observed three types of “adverse postoperative outcome”: death, hospital readmission, and complications within 30 days.

They found that, for women, treatment by a surgeon was associated with a 15% increase in the probability of an unfavorable outcome than if they were treated by a surgeon. However, the men did not experience differences whether they were treated by a male or female surgeon.

Similarly, women who were operated on by a surgeon had a 32% higher risk of death than those whose surgery had been performed by a woman. For example, while 1.4% of women who underwent cardiothoracic surgery with a male surgeon died, fewer (1%) did so when a female surgeon was involved. In both cerebral and vascular surgery, while 1.2% of women who underwent any type of operation with a male surgeon died, again that proportion was much lower among those whose surgeon was female – 0.9% – which gives 33 % higher risk of death.

Overall, female patients also had a 16% higher risk of complications and an 11% higher risk of readmission, and were 20% more likely to have to stay in the hospital longer.

Women were at increased risk of death, readmission, or complications when a man performed the operation in many of the 21 types of surgery analyzed.

For example, while 20.2% of women who underwent cardiothoracic (chest) surgery by a male surgeon experienced some type of adverse reaction, a lower percentage, 18%, did so if their surgeon it was a woman. The same pattern was observed in general surgery, brain surgery, and orthopedic surgery.

Technical differences between male and female surgeons are unlikely to explain the findings “since both genders receive the same technical medical training,” Jerath said.

“Implicit sexual biases,” in which surgeons “act on deeply ingrained subconscious biases, stereotypes and attitudes,” may be one possible explanation, he said. Differences in communication and interpersonal skills of men and women evident in surgeons’ discussions with patients before the operation is performed may also be a factor, he added. And “differences between the style of work, decision making and judgment of male and female doctors.”

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Fiona Myint, Vice President of the Royal College of Surgeons of England, noted that 86% of consulting (senior) surgeons in Britain were men.

“Surgery is still a long way from having a gender balance in its workforce. Women make up 41% of early stage surgeons, but only 30% of senior trainees and 14% of consultants, ”he said. Paternity, “the lack of flexibility in [surgical] training schedules and shifts ”and“ negative attitudes toward non-full-time training ”explain why many women do not become consulting surgeons, he added.

Scarlett McNally, who has been a consulting orthopedic surgeon for 20 years, said there is “growing evidence of a different experience for female surgeons, many of whom have postponed surgery and report historical ‘microaggressions’.” Additionally, patients may feel more comfortable talking to a surgeon before the operation, including steps they need to take to improve their chances of a good outcome, such as quitting smoking to help ensure a bone graft is performed, he added.

McNally also cited “unconscious bias” – assumptions among senior surgeons, nurses, administrators and patients that medical students or young doctors will not want to pursue a career in surgery – as a factor.

“Having more female surgeons would improve outcomes for all patients,” he said.

The Royal College of Surgeons of England said the findings were “interesting. Much more detailed research is required looking at communication, trust, and doctor-patient relationships. “