Patients Get Better Results When Treated by Female Surgeons

From a Wall Street Journal story by Julie Wernau headlined “Female Surgeons Get Better Results Than Their Male Counterparts”:

In a male dominated industry, female surgeons spend more time in the operating room and their patients endure fewer postoperative complications.

That’s the conclusion of two research studies published Wednesday in JAMA Surgery. Researchers found better outcomes for patients treated by female surgeons in the sweeping reviews of millions of procedures in Canada and Sweden.

In the first study, 17 researchers in the U.S. and Canada followed the outcomes for 1.2 million patients in Canada undergoing common surgeries between 2007 and 2020.

The study authors found that at both 90 days and one year following surgery, patients treated by female surgeons were less likely to experience adverse postoperative issues, including death. The outcome differences were modest, but consistent.

Even after statistically accounting for characteristics that may affect surgical outcomes, such as patient age and overall illness, surgeon experience and volume, hospital setting, and measures of case complexity, the authors reached the same conclusion. The study also found that when male surgeons treat female patients, outcomes are slightly worse.

The findings reveal that patients’ outcomes aren’t just about what happens in the operating room, said Dr. Angela Jerath, an author on the study and anesthesiologist and associate professor at the department of anesthesiology and pain medicine at the University of Toronto.

“Picking up problems early is where you start to save patients,” she said.

Jerath said the differences aren’t about technical skill, but about listening to patients and choosing appropriate care. Previous studies point to differences in the way that female physicians communicate and engage with patients.

Patients treated by male surgeons had postoperative complications about 14% of the time versus 12.5% of the time for female surgeons 90 days post surgery. And at one year post surgery, male-treated patients had adverse postoperative events 25% of the time, versus 20% of the time for female-treated patients.

Overall, patients experienced complications 9% of the time when treated by female surgeons and 10.2% of the time when treated by male surgeons.

Ashish Jha, dean at Brown University School of Public Health in Providence, R.I., who has separately studied sex differences in patient outcomes, said it is important that hospital systems look at their own data and practices to see what underlies the phenomenon.

“It’s not realistic or desirable that we only have female surgeons,” he said. “We want everyone to get better.”

Surgical professions are still largely dominated by men. In 2021, 22.6% of general surgeons in the U.S. were women, and orthopedic surgery had the lowest representation of female surgeons (5.9%), according to the Association of American Medical Colleges.

“Surgery is not a friendly place for women in general. The women who are getting into surgery are highly skilled,” said Christopher Wallis, lead author on the study, a urologic oncologist and assistant professor of urology at the University of Toronto.

Another study published in JAMA Surgery on Wednesday looked at more than 100,000 patients in Sweden who’d had surgery to remove their gallbladders. Female surgeons had longer operation times, but their patients had shorter hospital stays and less invasive surgeries.

Male surgeons spent a mean of eight minutes less per operation compared with women, even after matching similar patients, surgeries and hospitals. Complications including bleeding, perforations of the intestine or bowel, bile duct lesions, leakage and abscesses occurred nearly 30% more often for male surgeons.

“In clinical practice it is important to promote safety and caution in favor of speed, especially when we educate younger surgeons, regardless of the surgeon’s gender,” said Dr. My Blohm, lead author of the study and general surgeon and a Ph.D. student at the Karolinska Institute in Stockholm.

he studies back up a growing body of literature that points to better outcomes for patients of female doctors.

Researchers are just beginning to uncover the reasons behind these differences, which can only be seen across large averages, and they warned that gender shouldn’t be the basis for choosing a physician.

Dr. Sharon Stein, professor of surgery in the division of colon and rectal surgery at Case Western Reserve University School of Medicine and past president of the Association of Women Surgeons, said if these studies show us anything, it is that there’s a preponderance of evidence that female surgeons are as competent as male surgeons.

“The norm for surgery has been for a long time that you’re a man,” she said. “It’s a profession that’s very hierarchical and changing slowly.”

She said more senior women in leadership positions are having an effect on younger women’s interest in going into surgery. Still, it can be hard to fight against the big-male-energy surgeon stereotype.

A review published in 2017 of Medicare data found that physicians who referred a patient to a female surgeon and had a bad outcome weren’t only less likely to refer to that surgeon again, but also less likely to refer to any female surgeons. There was no such spillover effect to other male surgeons when a patient had a bad experience with a male surgeon.

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