剖宫产术后产妇发病率与外科医生性别之间的关联。

Association Between Surgeon Gender and Maternal Morbidity After Cesarean Delivery.

机构信息

Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France.

Université Paris Cité, CRESS, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, DHU Risks in Pregnancy, Paris, France.

出版信息

JAMA Surg. 2023 Mar 1;158(3):273-281. doi: 10.1001/jamasurg.2022.7063.

DOI:10.1001/jamasurg.2022.7063

PMID:36696127

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9878430/

Abstract

IMPORTANCE

The stereotype that men perform surgery better than women is ancient. Surgeons have long been mainly men, but in recent decades an inversion has begun; the number of women surgeons is increasing, especially in obstetrics and gynecology. Studies outside obstetrics suggest that postoperative morbidity and mortality may be lower after surgery by women.

OBJECTIVE

To evaluate the association between surgeons' gender and the risks of maternal morbidity and postpartum hemorrhage (PPH) after cesarean deliveries.

DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study was based on data from the Tranexamic Acid for Preventing Postpartum Hemorrhage after Cesarean Delivery (TRAAP2) trial, a multicenter, randomized, placebo-controlled trial that took place from March 2018 through January 2020 (23 months). It aimed to investigate whether the administration of tranexamic acid plus a prophylactic uterotonic agent decreased PPH incidence after cesarean delivery compared with a uterotonic agent alone. Women having a cesarean delivery before or during labor at or after 34 weeks' gestation were recruited from 27 French maternity hospitals.

EXPOSURES

Self-reported gender (man or woman), assessed by a questionnaire immediately after delivery.

MAIN OUTCOMES AND MEASURES

The primary end point was the incidence of a composite maternal morbidity variable, and the secondary end point was the incidence of PPH (the primary outcome of the TRAAP2 trial), defined by a calculated estimated blood loss exceeding 1000 mL or transfusion by day 2.

RESULTS

Among 4244 women included, men surgeons performed 943 cesarean deliveries (22.2%) and women surgeons performed 3301 (77.8%). The rate of attending obstetricians was higher among men (441 of 929 [47.5%]) than women (687 of 3239 [21.2%]). The risk of maternal morbidity did not differ for men and women surgeons: 119 of 837 (14.2%) vs 476 of 2928 (16.3%) (adjusted risk ratio, 0.92 [95% CI, 0.77-1.13]). Interaction between surgeon gender and level of experience on the risk of maternal morbidity was not statistically significant. Similarly, the groups did not differ for PPH risk (adjusted risk ratio, 0.98 [95% CI, 0.85-1.13]).

CONCLUSIONS AND RELEVANCE

Risks of postoperative maternal morbidity and of PPH exceeding 1000 mL or requiring transfusion by day 2 did not differ by the surgeon's gender.

摘要

重要性

男性比女性更擅长手术的刻板印象由来已久。长期以来，外科医生主要是男性，但近几十年来，这种情况开始发生逆转；女外科医生的数量正在增加，尤其是在妇产科。妇产科以外的研究表明，女性进行手术后的发病率和死亡率可能更低。

目的

评估外科医生的性别与剖宫产术后产妇发病率和产后出血（PPH）风险之间的关联。

设计、地点和参与者：本前瞻性队列研究基于 Tranexamic Acid for Preventing Postpartum Hemorrhage after Cesarean Delivery（TRAAP2）试验的数据，该试验是一项多中心、随机、安慰剂对照试验，于 2018 年 3 月至 2020 年 1 月（23 个月）进行。旨在调查与单独使用宫缩剂相比，给予氨甲环酸加预防性宫缩剂是否可降低剖宫产术后 PPH 的发生率。从 27 家法国产科医院招募了在产程中或产程后进行剖宫产术的 34 周以上妊娠的女性。

暴露

在分娩后立即通过问卷评估自我报告的性别（男性或女性）。

主要结局和测量指标

主要终点是复合产妇发病率变量的发生率，次要终点是 PPH 的发生率（TRAAP2 试验的主要结局），定义为计算出的失血量超过 1000 mL 或术后第 2 天输血。

结果

在 4244 名纳入的女性中，男性外科医生进行了 943 次剖宫产术（22.2%），女性外科医生进行了 3301 次剖宫产术（77.8%）。男性外科医生中产科医生的比例较高（441 名/929 名[47.5%]），而女性外科医生的比例较低（687 名/3239 名[21.2%]）。男性和女性外科医生的产妇发病率风险没有差异：837 名男性中的 119 名（14.2%）与 2928 名女性中的 476 名（16.3%）（校正风险比，0.92 [95%CI，0.77-1.13]）。外科医生性别和经验水平之间的交互作用在统计学上没有显著差异。同样，两组在 PPH 风险方面也没有差异（校正风险比，0.98 [95%CI，0.85-1.13]）。