Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City, Iowa, United States of America.
Department of Anesthesiology, Perioperative Medicine & Pain Management, Miller School of Medicine, University of Miami, Miami, Florida.
PLoS One. 2023 Mar 15;18(3):e0283033. doi: 10.1371/journal.pone.0283033. eCollection 2023.
A recent publication reported that at three hospitals within one academic health system, female surgeons received less surgical block time than male surgeons, suggesting potential gender-based bias in operating room scheduling. We examined this observation's generalizability.
Our cross-sectional retrospective cohort study of State of Florida administrative data included all 4,176,551 ambulatory procedural encounters and inpatient elective surgical cases performed January 2017 through December 2019 by 8875 surgeons (1830 female) at all 609 non-federal hospitals and ambulatory surgery centers. There were 1,509,190 lists of cases (i.e., combinations of the same surgeon, facility, and date). Logistic regression adjusted for covariables of decile of surgeon's quarterly cases, surgeon's specialty, quarter, and facility.
Selecting randomly a male and a female surgeons' quarter, for 66% of selections, the male surgeon performed more cases (P < .0001). Without adjustment for quarterly caseloads, lists comprised one case for 44.2% of male and 54.6% of female surgeons (difference 10.4%, P < .0001). A similar result held for lists with one or two cases (difference 9.1%, P < .0001). However, incorporating quarterly operative caseloads, the direction of the observed difference between male and female surgeons was reversed both for case lists with one (-2.1%, P = .03) or one or two cases (-1.8%, P = .05).
Our results confirm the aforementioned single university health system results but show that the differences between male and female surgeons in their lists were not due to systematic bias in operating room scheduling (e.g., completing three brief elective cases in a week on three different workdays) but in their total case numbers. The finding that surgeons performing lists comprising a single case were more often female than male provides a previously unrecognized reason why operating room managers should help facilitate the workload of surgeons performing only one case on operative (anesthesia) workdays.
最近的一篇出版物报道称，在一个学术医疗系统内的三家医院中，女性外科医生接受的手术块时间少于男性外科医生，这表明手术室排班中存在潜在的性别偏见。我们检查了这一观察结果的普遍性。
我们对佛罗里达州行政数据进行了横断面回顾性队列研究，包括 2017 年 1 月至 2019 年 12 月期间由 8875 名外科医生（1830 名女性）在所有 609 家非联邦医院和门诊手术中心进行的 4176551 例门诊程序和住院择期手术病例。共有 1509190 个病例清单（即相同外科医生、设施和日期的组合）。逻辑回归调整了外科医生季度病例的十分位数、外科医生的专业、季度和设施的协变量。
随机选择一位男性和一位女性外科医生的季度，在 66%的选择中，男性外科医生进行了更多的手术（P<0.0001）。如果不调整季度工作量，男性外科医生的病例清单中有一个病例的比例为 44.2%，女性外科医生的比例为 54.6%（差异 10.4%，P<0.0001）。对于有一个或两个病例的清单，结果类似（差异 9.1%，P<0.0001）。然而，在纳入季度手术工作量后，男性和女性外科医生的观察到的差异方向发生了逆转，对于有一个病例的病例清单（-2.1%，P=0.03）或有一个或两个病例的清单（-1.8%，P=0.05）。
我们的结果证实了上述单一大学健康系统的结果，但表明男性和女性外科医生在其病例清单中的差异不是由于手术室排班中的系统偏见（例如，在三个不同的工作日完成三个简短的择期手术），而是由于他们的总病例数量。在仅进行一个病例的手术（麻醉）工作日上，执行仅包含一个病例的清单的外科医生的女性比例通常高于男性，这一发现提供了一个以前未被认识到的原因，为什么手术室经理应该帮助促进仅执行一个病例的外科医生的工作量。
