Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan.
Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
JAMA Surg. 2022 Sep 1;157(9):e222938. doi: 10.1001/jamasurg.2022.2938. Epub 2022 Sep 14.
Women are vastly underrepresented in surgical leadership and management in Japan. The lack of equal opportunities for surgical training is speculated to be the main reason for this disparity; however, this hypothesis has not been investigated thus far.
To examine gender disparity in the number of surgical experiences among Japanese surgeons.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective, multicenter cross-sectional study used data from the National Clinical Database, which contains more than 95% of all surgical procedures in Japan. Participants included male and female gastroenterological surgeons who performed appendectomy, cholecystectomy, right hemicolectomy, distal gastrectomy, low anterior resection, and pancreaticoduodenectomy between January 1, 2013, and December 31, 2017.
Differences in the number of surgical experiences between male and female surgeons.
The primary outcomes were the total number of operations and number of operations per surgeon by gender and years of experience. Data were analyzed from March 18 to August 31, 2021.
Of 1 147 068 total operations, 83 354 (7.27%) were performed by female surgeons and 1 063 714 (92.73%) by male surgeons. Among the 6 operative procedures, the percentage of operations performed by female surgeons were the highest for appendectomy (n = 20 648 [9.83%]) and cholecystectomy (n = 41 271 [7.89%]) and lowest for low anterior resection (n = 4507 [4.57%]) and pancreaticoduodenectomy (n = 1329 [2.64%]). Regarding the number of operations per surgeon, female surgeons had fewer surgical experiences for all 6 types of operations in all years after registration, except for appendectomy and cholecystectomy in the first 2 years after medical registration. The largest gender disparity for each surgical procedure was 3.17 times more procedures for male vs female surgeons for appendectomy (at 15 years after medical registration), 4.93 times for cholecystectomy (at 30-39 years), 3.65 times for right hemicolectomy (at 30-39 years), 3.02 times for distal gastrectomy (at 27-29 years), 6.75 times for low anterior resection (at 27-29 years), and 22.2 times for pancreaticoduodenectomy (at 30-39 years).
This cross-sectional study found that female surgeons had less surgical experience than male surgeons in Japan, and this gap tended to widen with an increase in years of experience, especially for medium- and high-difficulty operations. Gender disparity in surgical experience needs to be eliminated, so that female surgeons can advance to leadership positions.
在日本，女性在外科领导和管理方面的代表性严重不足。人们推测，外科培训机会不平等是造成这种差异的主要原因；然而，这一假设尚未得到调查。
检查日本外科医生手术经验数量的性别差异。
设计、地点和参与者：这是一项回顾性、多中心的横断面研究，使用了国家临床数据库的数据，该数据库包含了日本 95%以上的所有手术。参与者包括 2013 年 1 月 1 日至 2017 年 12 月 31 日期间进行阑尾切除术、胆囊切除术、右半结肠切除术、远端胃切除术、低位前切除术和胰十二指肠切除术的男性和女性胃肠外科医生。
男女外科医生手术经验数量的差异。
主要结果是按性别和从业年限计算的总手术次数和每位外科医生的手术次数。数据于 2021 年 3 月 18 日至 8 月 31 日进行分析。
在 1147068 例总手术中，83354 例（7.27%）由女性外科医生完成，1063714 例（92.73%）由男性外科医生完成。在 6 种手术中，女性外科医生完成的手术百分比最高的是阑尾切除术（n=20648[9.83%]）和胆囊切除术（n=41271[7.89%]），最低的是低位前切除术（n=4507[4.57%]）和胰十二指肠切除术（n=1329[2.64%]）。关于每位外科医生的手术次数，除了注册后前 2 年的阑尾切除术和胆囊切除术外，所有 6 种手术中，女性外科医生在所有年份的手术经验都较少。每种手术的性别差异最大为 3.17 倍，即阑尾切除术男性外科医生比女性外科医生多 3.17 倍（注册后 15 年），胆囊切除术 4.93 倍（30-39 岁），右半结肠切除术 3.65 倍（30-39 岁），远端胃切除术 3.02 倍（27-29 岁），低位前切除术 6.75 倍（27-29 岁），胰十二指肠切除术 22.2 倍（30-39 岁）。
这项横断面研究发现，日本女性外科医生的手术经验少于男性外科医生，而且随着从业年限的增加，这种差距有扩大的趋势，尤其是在中、高难度手术中。需要消除外科手术经验方面的性别差异，以便女性外科医生能够晋升领导岗位。
