Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
Department of Surgery, Mora Hospital, Mora, Sweden.
JAMA Surg. 2023 Nov 1;158(11):1168-1175. doi: 10.1001/jamasurg.2023.3736.
Female surgeons are still in the minority worldwide, and highlighting gender differences in surgery is important in understanding and reducing inequities within the surgical specialty. Studies on different surgical procedures indicate equal results, or safer outcomes, for female surgeons, but it is still unclear whether surgical outcomes of gallstone surgery differ between female and male surgeons.
To examine the association of the surgeon's gender with surgical outcomes and operating time in elective and acute care cholecystectomies.
DESIGN, SETTING, AND PARTICIPANTS: A population-based cohort study based on data from the Swedish Registry of Gallstone Surgery was performed from January 1, 2006, to December 31, 2019. The sample included all registered patients undergoing cholecystectomy in Sweden during the study period. The follow-up time was 30 days. Data analysis was performed from September 1 to September 7, 2022, and updated March 24, 2023.
The surgeon's gender.
MAIN OUTCOME(S) AND MEASURE(S): The association between the surgeon's gender and surgical outcomes for elective and acute care cholecystectomies was calculated with generalized estimating equations. Differences in operating time were calculated with mixed linear model analysis.
A total of 150 509 patients, with 97 755 (64.9%) undergoing elective cholecystectomies and 52 754 (35.1%) undergoing acute care cholecystectomies, were operated on by 2553 surgeons, including 849 (33.3%) female surgeons and 1704 (67.7%) male surgeons. Female surgeons performed fewer cholecystectomies per year and were somewhat better represented at universities and private clinics. Patients operated on by male surgeons had more surgical complications (odds ratio [OR], 1.29; 95% CI, 1.19-1.40) and total complications (OR, 1.12; 95% CI, 1.06-1.19). Male surgeons had more bile duct injuries in elective surgery (OR, 1.69; 95% CI, 1.22-2.34), but no significant difference was apparent in acute care operations. Female surgeons had significantly longer operation times. Male surgeons converted to open surgery more often than female surgeons in acute care surgery (OR, 1.22; 95% CI, 1.04-1.43), and their patients had longer hospital stays (OR, 1.21; 95% CI, 1.11-1.31). No significant difference in 30-day mortality could be demonstrated.
The results of this cohort study indicate that female surgeons have more favorable outcomes and operate more slowly than male surgeons in elective and acute care cholecystectomies. These findings may contribute to an increased understanding of gender differences within this surgical specialty.
女性外科医生在全球范围内仍然占少数，强调手术中的性别差异对于理解和减少外科专业中的不平等至关重要。不同手术程序的研究表明，女性外科医生的结果相等，或者手术安全性更高，但仍不清楚胆囊切除术的手术结果是否因外科医生的性别而异。
研究外科医生的性别与择期和急症胆囊切除术的手术结果和手术时间之间的关联。
设计、设置和参与者：基于瑞典胆囊结石手术登记处的数据，进行了一项基于人群的队列研究，研究时间为 2006 年 1 月 1 日至 2019 年 12 月 31 日。样本包括研究期间在瑞典接受胆囊切除术的所有登记患者。随访时间为 30 天。数据分析于 2022 年 9 月 1 日至 9 月 7 日进行，并于 2023 年 3 月 24 日更新。
外科医生的性别。
使用广义估计方程计算择期和急症胆囊切除术的外科医生性别与手术结果之间的关联。使用混合线性模型分析计算手术时间的差异。
共有 150509 名患者接受了 2553 名外科医生的手术，其中 97755 名（64.9%）接受了择期胆囊切除术，52754 名（35.1%）接受了急症胆囊切除术。包括 849 名（33.3%）女性外科医生和 1704 名（67.7%）男性外科医生。女性外科医生每年进行的胆囊切除术较少，且在大学和私人诊所的代表人数略多。接受男性外科医生手术的患者有更多的手术并发症（比值比[OR]，1.29；95%置信区间[CI]，1.19-1.40）和总并发症（OR，1.12；95% CI，1.06-1.19）。男性外科医生在择期手术中更有可能发生胆管损伤（OR，1.69；95% CI，1.22-2.34），但在急症手术中没有明显差异。女性外科医生的手术时间明显更长。男性外科医生在急症手术中比女性外科医生更常转为开放手术（OR，1.22；95% CI，1.04-1.43），且他们的患者住院时间更长（OR，1.21；95% CI，1.11-1.31）。30 天死亡率无显著差异。
这项队列研究的结果表明，女性外科医生在择期和急症胆囊切除术中的结果优于男性外科医生，手术速度也较慢。这些发现可能有助于增加对该外科专业内性别差异的理解。
