Wallis Christopher Jd, Ravi Bheeshma, Coburn Natalie, Nam Robert K, Detsky Allan S, Satkunasivam Raj
Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, ON M4N 3M5, Canada.
Institute of Health Policy, Management, and Evaluation, University of Toronto.
BMJ. 2017 Oct 10;359:j4366. doi: 10.1136/bmj.j4366.
To examine the effect of surgeon sex on postoperative outcomes of patients undergoing common surgical procedures. Population based, retrospective, matched cohort study from 2007 to 2015. Population based cohort of all patients treated in Ontario, Canada. Patients undergoing one of 25 surgical procedures performed by a female surgeon were matched by patient age, patient sex, comorbidity, surgeon volume, surgeon age, and hospital to patients undergoing the same operation by a male surgeon. Sex of treating surgeon. The primary outcome was a composite of death, readmission, and complications. We compared outcomes between groups using generalised estimating equations. 104 630 patients were treated by 3314 surgeons, 774 female and 2540 male. Before matching, patients treated by female doctors were more likely to be female and younger but had similar comorbidity, income, rurality, and year of surgery. After matching, the groups were comparable. Fewer patients treated by female surgeons died, were readmitted to hospital, or had complications within 30 days (5810 of 52 315, 11.1%, 95% confidence interval 10.9% to 11.4%) than those treated by male surgeons (6046 of 52 315, 11.6%, 11.3% to 11.8%; adjusted odds ratio 0.96, 0.92 to 0.99, P=0.02). Patients treated by female surgeons were less likely to die within 30 days (adjusted odds ratio 0.88; 0.79 to 0.99, P=0.04), but there was no significant difference in readmissions or complications. Stratified analyses by patient, physician, and hospital characteristics did not significant modify the effect of surgeon sex on outcome. A retrospective analysis showed no difference in outcomes by surgeon sex in patients who had emergency surgery, where patients do not usually choose their surgeon. After accounting for patient, surgeon, and hospital characteristics, patients treated by female surgeons had a small but statistically significant decrease in 30 day mortality and similar surgical outcomes (length of stay, complications, and readmission), compared with those treated by male surgeons. These findings support the need for further examination of the surgical outcomes and mechanisms related to physicians and the underlying processes and patterns of care to improve mortality, complications, and readmissions for all patients.
为研究外科医生性别对接受常见外科手术患者术后结局的影响。基于人群的回顾性匹配队列研究，时间跨度为2007年至2015年。研究对象为加拿大安大略省所有接受治疗的患者组成的基于人群的队列。接受25种由女外科医生实施的外科手术之一的患者，按照患者年龄、患者性别、合并症、外科医生手术量、外科医生年龄和医院，与接受同类型手术的男外科医生治疗的患者进行匹配。治疗外科医生的性别。主要结局为死亡、再入院和并发症的综合情况。我们使用广义估计方程比较了组间结局。104630名患者接受了3314名外科医生的治疗，其中女医生774名，男医生2540名。匹配前，女医生治疗的患者更可能为女性且年龄更小，但合并症、收入、居住地区和手术年份相似。匹配后，两组具有可比性。女外科医生治疗的患者在30天内死亡、再次入院或发生并发症的人数更少（52315例中有5810例，占11.1%，95%置信区间为10.9%至11.4%），低于男外科医生治疗的患者（52315例中有6046例，占11.6%，11.3%至11.8%；校正比值比为0.96，0.92至0.99，P = 0.02）。女外科医生治疗的患者在30天内死亡的可能性更低（校正比值比为0.88；0.79至0.99，P = 0.04），但再入院或并发症方面无显著差异。按患者、医生和医院特征进行的分层分析并未显著改变外科医生性别对结局的影响。一项回顾性分析显示，在急诊手术患者中（这类患者通常无法选择外科医生），外科医生性别对结局无差异。在考虑患者、外科医生和医院特征后，与男外科医生治疗的患者相比，女外科医生治疗的患者30天死亡率有小幅但具有统计学意义的降低，且手术结局（住院时间、并发症和再入院情况）相似。这些发现支持有必要进一步研究与医生相关的手术结局和机制，以及潜在的医疗过程和模式，以改善所有患者的死亡率、并发症和再入院情况。
