Patients treated by female surgeons have slightly lower death rates: study
The researchers compared the procedural outcomes of 104,630 patients undergoing a broad range of surgeries by 3,314 surgeons between 2007 and 2016 in Ontario.
Patients treated by female surgeons instead of their male counterparts had slightly lower death rates in the weeks following their procedures, according to a new study.
The findings, published in the medical journal The BMJ on Tuesday, showed a small difference in the post-operative results between female and male surgeons practising in Ontario.
The team of researchers led by Dr. Raj Satkunasivam, a Houston Methodist surgeon and researcherwho was working at the University of Toronto during the time of the study, wanted to see if a surgeon’s gender had an effect on patients’ health in the first month after a procedure.
“We wanted to see if there was a difference in postoperative outcome, for example, death, complications or readmissions between patients who are treated by male and female surgeons,” Satkunasivam told CTVNews.ca in a phone interview on Tuesday.
They compared the procedural outcomes of 104,630 patients undergoing a broad range of surgeries by 3,314 surgeons between 2007 and 2016 in Ontario. Of the surgeons followed, 774 were female and 2,540 were male.
“We looked at every single surgical disciplinethat you can think of, from orthopedic surgery to cardiac surgery to general surgery, and we selected out procedures that we thought were common in each of these specialties and we picked a total of 25 different procedures,” Satkunasivam explained.
In order to ensure balance in thecomparisons, Dr. Christopher Wallis, a urology surgery resident at the University of Toronto who worked on the study, told CTVNews.ca that researchers matched the patients of both genders for age, sex, income and other medical conditions. The surgeons themselves were also matched for age, experience, number of operations they performed in the last year, and the hospital they worked in.
“We’ve done what we call case-mix adjusting where we adjust for differences in the patient, in the surgeon and in the hospital to say the only real differences is whether that patient’s surgeon was male or female,” Wallis said. “In doing this, we get as close as possible to comparing the effects of surgeon’s sex.”
Wallisnoted, however, that because the study was observational rather than a true experiment with complete control over every factor, there’s a chance other influences impacted the results.
Lower death rates
In the end, the researchers found a 4 per cent reduced mortality rate in the patients of female surgeons compared to those of male surgeons. Although the study’s authors acknowledged the difference was “small,” they still said the results have “potentially significant clinical implications” and support the need for further study.
“We have good evidence to support the notion that female surgeons are definitely as good as their male counterparts and certainly we’ve got evidence to say that they’re possibly better for a variety of reasons,” Satkunasivam said.
Although death rateswere lower among patients of female surgeons, the study noted that there was no difference in rates of readmission to the hospital or complications in the month following an operation by female or male doctors. There was also no variance in the outcomes of patients of surgeons of either gender who underwent emergency surgery.
The researchers said it’s unclear why patients of female surgeonshad lower death rates, but theorized that it may be related to “the delivery of care that is more in line with guidelines, more patient-centred, and involves better communication,” in accordance with qualitative research that’s been conducted in the past.
Additionally, Wallis said that historically it’s been more difficult for women to be admitted and advance in a career in surgery.
“The women who are able to pass this [higher] bar have faced higher hurdles than the men who get into surgery so it’s therefore reasonable to expect they may be either smarter, more talented, harder working, more dedicated,” he said. “There’s something about them that makes them better because they’ve had to overcome larger obstacles.”
Despite the study’s professed intention to support gender equality and diversity in a traditionally male-dominated profession, critics have suggested that comparing male and female surgeons is “an unproductive distraction.”
In an editorial published in the BMJ, Clare Marx and Derek Alderson from The Royal College of Surgeons of England argued that the study fails to look at patients’ longer-term outcomes after surgery and that studying such a small difference in short-term results is “unlikely to prove worthwhile.”
Both Satkunasivam and Wallis acknowledged there were limitations to their study and said that although an association could be established between female surgeons and lower mortality rates, definitive causation couldn’t be determined with certainty. Because of this, Satkunasivam stressed that patients shouldn’t worry about the sex of their surgeon.
“They should really be concerned more about the type of rapport they have with them, the type of recommendation that their family placed in that surgeon and the research that they’ve done,” he said.
The researchers said they believe it’s worth exploring the differences in the way that women and men practice medicine in case there are potentially significant variations that will benefit future education in the field.