A study published recently in JAMA Surgery suggests that female surgeons may achieve better outcomes than male surgeons—and choosing a female surgeon could be even more beneficial for female patients, Nicholas Bakalar reports for the New York Times.

Study details

For the study, researchers analyzed patient records from 559,903 male patients and 760,205 female patients who were operated on by 2,937 surgeons between 2007-2019 in Ontario, Canada.

Among the male patients, about 91% had male surgeons, and 9% had female surgeons. Among the female patients, 88% had male surgeons, and 12% had female surgeons.

On average, the female surgeons in the study were younger, performed fewer surgeries, and operated on patients who were generally healthier than those operated on by the male surgeons. The researchers controlled for these differences between male and female surgeons, differences in patient characteristics, and the type of hospital in which the surgery was performed, such as a community hospital or a major academic medical center.

In their analysis, researchers looked at 21 common elective and emergency surgeries, including cardiac, orthopedic, urological, head and neck, thoracic, vascular, neurological, and plastic surgery. The analyzed operations included coronary artery bypass grafting, appendectomy, carpal tunnel release, gastric bypass, spinal surgery, thyroid surgery, and knee and hip replacement.

Findings

Overall, about 15% of the study's patients experienced post-operative complications. In particular, 8.7% of patients had significant complications within 30 days of their operation, 6.7% were readmitted to the hospital, and 1.7% died.

In addition, the researchers discovered that when the sex of the surgeon and patient were different, the surgery had a slightly lesser chance of being successful. In these cases, researchers observed an 8% increase in postoperative complications or death—but there was no difference in readmissions to the hospital. This pattern remained consistent across different types of surgery and patient characteristics.

However, researchers found that female surgeons were more successful overall than male surgeons. Notably, the worst surgical outcomes were recorded when female patients had male surgeons. In the study, when female patients were treated by male surgeon, they were about 15% more likely to experience complications, readmission to the hospital, or death within 30 days of their procedure.

According to the authors, the study has some limitations. Most notably, it was observational, meaning the researchers were not able to control for nurses and other staff. In addition, the data excluded robotic operations because they were not common in Ontario when the study was conducted.

Commentary

Margaret Mueller, a surgeon and associate professor of gynecology at Northwestern University who was not involved in the research, acknowledged the study's "smart design," adding that it was well controlled, with a large database. "We now have some objective data showing that there are superior outcomes with female surgeons," Mueller said. "We just don't know the reasons."

According to Christopher Wallis, the study's lead author and an assistant professor of urology at the University of Toronto, there is no indication of differences between female and male surgeons' technical skills. Instead, he proposed that the issue could partially stem from differences in communication styles, namely the way surgeons speak to male and female patients.

Separately, Angela Jerath, the second author on the study and an associate professor of anesthesiology at the University of Toronto, noted that when she works as an anesthesiologist alongside a female surgeon, the atmosphere in the operating room is generally more collegial, which she suggested may result in better communication and improved teamwork in the operating room.

"Female surgeons ask me more questions," Jerath said. "Maybe women are more collaborative. Maybe they are more detail oriented. Maybe they are more meticulous. We can't answer these questions with our data."

Further, Wallis noted that doctors may also treat male and female patients differently after an operation.

"We know that women's pain is not given as much credence as men's pain," Wallis said. "In postoperative care, this can be complex. To some degree, pain is an expected outcome of surgery, but it can also suggest an early sign of a complication. Doctors must be able to read the symptoms and at the same time have a demeanor that welcomes patients to present information in a way that we can head off problems before they happen."

"I'd like surgeons to be able to take a step back," Jerath advised. "Be thoughtful—something is happening here. Let's look at it and be open to solutions." (Bakalar, New York Times, 2/8; Wallis et al., JAMA Surgery, 12/8/2021)