New research from scientists at Sunnybrook, University Health Network and the University of Toronto is calling into question whether the sex of your surgeon could impact your outcomes after surgery.
The study, recently published in JAMA Surgery, looked at 1.3 million patients treated by nearly 3000 surgeons between 2007 and 2019 in Ontario, measuring adverse postoperative outcomes such as death, readmission and complications 30 days following a surgical procedure. The researchers analyzed associations between surgeon-patient sex concordance (male surgeon with male patient, female surgeon with female patient) or discordance (male surgeon with female patient, female surgeon with male patient). They looked at outcomes following 21 different procedures in a variety of surgical specialties.
“Previous research in the emergency care setting has shown that sex discordance, particularly among male physicians and female patients, can be associated with some adverse effects,” says Dr. Angela Jerath, one of the co-authors of the study and an anesthesiologist and scientist at Sunnybrook. “We were interested in exploring whether this was similarly the case in regards to surgical outcomes.”
The researchers found that female patients were 15% more likely to experience adverse outcomes following common surgical procedures when treated by a male rather than a female surgeon. When a male surgeon operated on a female patient – compared with a female surgeon – there was a 32 per cent increase in the likelihood of a female patient’s death in the 30 days following the procedure. In contrast, for male patients, there was no difference in outcomes whether they were treated by female surgeons or male surgeons.
“These results are concerning because the sex of patients and surgeons should not result in differences in patient outcomes after surgery,” says Dr. Jerath. “As an anesthesiologist I know there are many excellent male surgeons who consistently have good outcomes. However, at a population level, the analysis does signal a concerning difference between male and female surgeons overall and its impact on patient outcomes, which needs to be explored.”
The researchers say more work is needed to determine the cause of the disparities. Dr. Christopher Wallis, who co-led the study explains it’s unlikely the findings are the result of technical difficulties between sexes. “Both male and female surgeons undergo the same technical medical training. The very large sample size and the examination of many different surgical specialties would have diluted any technical differences between male and female surgeons. We believe there are other complex factors at play,” says Dr. Wallis, a urologic oncologist in the Division of Urology at Mount Sinai Hospital and University Health Network.
The authors propose implicit sex biases, differing communication or interpersonal skills which may influence trust, and variations in decision making and clinical judgement as potential factors contributing to the disparities.
“Previous research has also shown that symptoms reported by female patients may be under-appreciated in the health care setting (particularly among male physicians). Thus, early symptoms of complications may be missed when they can be mitigated and instead manifest as more severe events,” says Dr. Wallis.
The researchers add the study highlights the need to diversify the workforce to better serve the patients they are treating. “This work really emphasizes the importance of changing the culture of medicine to promote the role of women in our field,” says Dr. Wallis.
Although more research is needed, the authors say their advice to patients is to ensure they have a good, trusting relationship with their surgeon regardless of sex. “The patient-surgeon relationship is extremely important,” says Dr. Jerath. “Patients want to ensure they can openly discuss their questions and concerns before, during and after surgery.”