Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada.
JAMA Surg. 2023 Nov 1;158(11):1185-1194. doi: 10.1001/jamasurg.2023.3744.
Sex- and gender-based differences in a surgeon's medical practice and communication may be factors in patients' perioperative outcomes. Patients treated by female surgeons have improved 30-day outcomes. However, whether these outcomes persist over longer follow-up has not been assessed.
To examine whether surgeon sex is associated with 90-day and 1-year outcomes among patients undergoing common surgeries.
DESIGN, SETTING, AND PARTICIPANTS: A population-based retrospective cohort study was conducted in adults in Ontario, Canada, undergoing 1 of 25 common elective or emergent surgeries between January 1, 2007, and December 31, 2019. Analysis was performed between July 15 and October 20, 2022.
Surgeon sex.
An adverse postoperative event, defined as the composite of death, readmission, or complication, was assessed at 90 days and 1 year following surgery. Secondarily, each of these outcomes was assessed individually. Outcomes were compared between patients treated by female and male surgeons using generalized estimating equations with clustering at the level of the surgical procedure, accounting for patient-, procedure-, surgeon-, anesthesiologist-, and facility-level covariates.
Among 1 165 711 included patients, 151 054 were treated by a female and 1 014 657 by a male surgeon. Overall, 14.3% of the patients had 1 or more adverse postoperative outcomes at 90 days and 25.0% had 1 or more adverse postoperative outcomes 1 year following surgery. Among these, 2.0% of patients died within 90 days and 4.3% died within 1 year. Multivariable-adjusted rates of the composite end point were higher among patients treated by male than female surgeons at both 90 days (13.9% vs 12.5%; adjusted odds ratio [AOR], 1.08; 95% CI, 1.03-1.13) and 1 year (25.0% vs 20.7%; AOR, 1.06; 95% CI, 1.01-1.12). Similar patterns were observed for mortality at 90 days (0.8% vs 0.5%; AOR 1.25; 95% CI, 1.12-1.39) and 1 year (2.4% vs 1.6%; AOR, 1.24; 95% CI, 1.13-1.36).
After accounting for patient, procedure, surgeon, anesthesiologist, and hospital characteristics, the findings of this cohort study suggest that patients treated by female surgeons have lower rates of adverse postoperative outcomes including death at 90 days and 1 year after surgery compared with those treated by male surgeons. These findings further support differences in patient outcomes based on physician sex that warrant deeper study regarding underlying causes and potential solutions.
外科医生在医疗实践和沟通中存在的性别差异可能是影响患者围手术期结局的因素。接受女性外科医生治疗的患者 30 天结局得到改善。然而，这些结局是否在更长时间的随访中持续，尚未得到评估。
研究外科医生的性别是否与接受 25 种常见择期或紧急手术之一的患者在 90 天和 1 年时的结局相关。
设计、环境和参与者：这是一项在加拿大安大略省开展的基于人群的回顾性队列研究，纳入 2007 年 1 月 1 日至 2019 年 12 月 31 日期间接受 25 种常见择期或紧急手术之一的成年人。分析于 2022 年 7 月 15 日至 10 月 20 日进行。
外科医生的性别。
术后 90 天和 1 年评估复合不良术后事件，包括死亡、再入院或并发症。次要结局评估了每个结局。使用广义估计方程，在手术层面进行聚类，考虑患者、手术、外科医生、麻醉师和医疗机构层面的协变量，比较女性和男性外科医生治疗的患者之间的结局。
在纳入的 1165711 例患者中，有 151054 例由女性外科医生治疗，1014657 例由男性外科医生治疗。总体而言，90 天时有 14.3%的患者出现 1 个或多个不良术后结局，1 年时有 25.0%的患者出现 1 个或多个不良术后结局。其中，90 天内有 2.0%的患者死亡，1 年内有 4.3%的患者死亡。多变量调整后的复合终点发生率在 90 天（13.9%比 12.5%；调整后的优势比[OR]，1.08；95%CI，1.03-1.13）和 1 年（25.0%比 20.7%；OR，1.06；95%CI，1.01-1.12）时均更高。在 90 天（0.8%比 0.5%；OR，1.25；95%CI，1.12-1.39）和 1 年（2.4%比 1.6%；OR，1.24；95%CI，1.13-1.36）时也观察到了相似的死亡率模式。
在考虑了患者、手术、外科医生、麻醉师和医院特征后，这项队列研究的结果表明，与接受男性外科医生治疗的患者相比，接受女性外科医生治疗的患者在术后 90 天和 1 年时的不良术后结局（包括死亡）发生率较低。这些发现进一步支持了基于医生性别的患者结局差异，需要进一步研究潜在原因和潜在解决方案。
