From the Department of Anesthesiology, Weill Cornell Medicine, New York, New York.
Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York.
Anesth Analg. 2024 Nov 1;139(5):955-964. doi: 10.1213/ANE.0000000000006803. Epub 2024 May 20.
Women continue to be underrepresented in academic anesthesiology. This study assessed guidelines in anesthesia journals over the past 5 years, evaluating differences in woman-led versus man-led guidelines in terms of author gender, quality, and changes over time. We hypothesized that anesthesia guidelines would be predominately man-led, and that there would be differences in quality between woman-led versus man-led guidelines.
All clinical practice guidelines published in the top 10 anesthesia journals were identified as per Clarivate Analytics Impact Factor between 2016 and 2020. Fifty-one guidelines were included for author, gender, and quality analysis using the Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument. Each guideline was assessed across 6 domains and 23 items and given an overall score, overall quality score, and overall rating/recommendation. Stratified and trend analyses were performed for woman-led versus man-led guidelines.
Fifty out of 51 guidelines were included: 1 was excluded due to unidentifiable first-author gender. In total, 255 of 1052 (24%) authors were women, and woman-led guidelines (woman-first author) represented 12 of 50 (24%) overall guidelines. Eighteen percent (9 of 50) of guidelines had all-male authors, and a majority (26 of 50, 52%) had less than one-third of female authors. The overall number and percentage of woman-led guidelines did not change over time. There was a significantly higher percentage of female authors in woman-led versus man-led guidelines, median 39% vs 20% ( P = .012), as well as a significantly higher number of female coauthors in guidelines that were woman-led median 3.5 vs 1.0, P = .049. For quality, there was no significant difference in the overall rating or objective quality of woman- versus man-led guidelines. However, there was a significant increase in the overall rating of all the guidelines over time ( P = .010), driven by the increase in overall rating among man-led guidelines, P = .002. The overall score of guidelines did not increase over time; however, they increased in man-led but not woman-led guidelines. There was no significant correlation between the percentage of female authors per guideline and either overall score or overall rating.
There is a substantial disparity in the number of women leading and contributing to guidelines which has not improved over time. Woman-led guidelines included more women and a higher percentage of women. There was no difference in quality of guidelines by first-author gender or percentage of female authors. Further systematic and quota-driven sponsorship is needed to promote gender equity, diversity, and inclusion in anesthesia guidelines.
在学术麻醉学领域，女性的代表性仍然不足。本研究评估了过去 5 年麻醉学期刊中的指南，根据女性主导与男性主导指南在作者性别、质量以及随时间变化方面的差异进行了评估。我们假设麻醉指南将主要由男性主导，并且女性主导与男性主导指南之间在质量上存在差异。
根据 2016 年至 2020 年期间 Clarivate Analytics 影响因子，确定了前 10 名麻醉期刊中发表的所有临床实践指南。使用评估研究和评估指南 (AGREE II) 工具对 51 项指南进行了作者、性别和质量分析。根据 6 个领域和 23 个项目对每个指南进行了评估，并给出了总体评分、总体质量评分和总体建议/推荐。对女性主导与男性主导指南进行了分层和趋势分析。
共纳入 51 项指南中的 50 项：1 项因无法识别第一作者的性别而被排除在外。在总共 1052 位作者中，有 255 位（24%）为女性，而 50 项指南中有 12 项（24%）为女性主导。有 18%（9/50）的指南全部由男性作者撰写，大多数（50 项中的 26 项，52%）指南的女性作者不到三分之一。女性主导指南的数量和百分比在过去 5 年中没有变化。女性主导指南的女性作者比例明显高于男性主导指南，中位数分别为 39%和 20%（P=0.012），女性合著者的数量也明显多于男性主导指南，中位数分别为 3.5 和 1.0（P=0.049）。在质量方面，女性主导与男性主导指南的总体评分或客观质量没有显著差异。然而，所有指南的总体评分随着时间的推移显著增加（P=0.010），这主要是由于男性主导指南的总体评分增加所致，P=0.002。指南的总体评分没有随着时间的推移而增加；然而，它们在男性主导指南中增加了，但在女性主导指南中没有增加。指南中女性作者的比例与总体评分或总体评分之间没有显著相关性。
在领导和参与指南方面，女性的人数存在很大差距，而且这种差距随着时间的推移并没有得到改善。女性主导的指南纳入了更多的女性和更高比例的女性。第一作者性别或女性作者比例对指南质量没有影响。需要进一步进行系统的、定额驱动的赞助，以促进麻醉学指南中的性别平等、多样性和包容性。
