Battle of the sexes moves to the operating theatre – with a clear winner

Patients who go under the knife with a female surgeon have better postoperative outcomes than those with a male surgeon, a study suggests.

Previous research has shown patients treated by female surgeons have improved 30-day outcomes, but the latest study led by the University of Toronto assessed more than one million people at both 90 days and one year.

The retrospective study assessed the frequency of adverse postoperative events – either a complication, readmission or death – in patients treated for one of 25 elective or emergency surgeries between January 1, 2007 and December 31, 2019.

Of the 1,165,711 patients assessed, 151,054 were treated by female surgeons, and 1,014,657 by a male surgeon.

Across the cohort, 14.3% of patients had one or more postoperative events at 90 days and 25% at one year. Among those, 2% died within 90 days and 4.3% died within a year of surgery.

However, after accounting for patient, procedure, surgeon, anaesthesiologist and hospital characteristics, the findings suggested that patients fared better at both 90 days and one year when treated by a female surgeon.

Adverse postoperative outcomes for patients treated by male and female surgeons were 13.9% versus 12.5% respectively at 90 days, and 25% versus 20.7% at one year.

‘To our knowledge, these are the first data to assess the association between surgeon sex and outcomes beyond 30 days following surgery.’

The team also noted that a previous study found that male patients have better short-term outcomes when treated by female surgeons – an outcome significantly larger for female patients. However, due to the unequal workforce, it is not possible for all female patients to be treated by a female surgeon.

‘There are notable patient- and surgeon-level differences between patients treated by female and male surgeons,’ the team wrote. 

‘Many of these relate to the unequal distribution of women in the surgical workforce, however, other differences may relate to differences in the way that female and male surgeons practise, implicating them along the causal pathway rather than as confounders.’

Among the study’s limitations, they included the observational method and inability to account for the rest of the medical team, with the exception of anaesthesiologists.

A major strength was the study’s large, population-based dataset.

The team concluded: ‘Despite these data, women continue to be marginalised in the workplace in many ways.

‘To provide the best patient care, organisations should support women physicians and learn how they accomplish these improved outcomes.’

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