Heybati Kiyan, Satkunasivam Raj, Aminoltejari Khatereh, Thomas Hannah S, Salles Arghavan, Coburn Natalie, Wright Frances C, Gotlib Conn Lesley, Luckenbaugh Amy N, Ranganathan Sanjana, Riveros Carlos, Sutherland Jason, McCartney Colin, Armstrong Kathleen, Bass Barbara, Detsky Allan S, Jerath Angela, Wallis Christopher J D
From the Alix School of Medicine, Mayo Clinic, Rochester, MN.
Division of Plastic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Ann Surg Open. 2025 May 2;6(2):e569. doi: 10.1097/AS9.0000000000000569. eCollection 2025 Jun.
To determine associations between physician sex and use of postoperative healthcare resources among patients undergoing common surgeries in Ontario, Canada.
Prior studies have shown that patients of female physicians experience better outcomes and have lower healthcare costs compared with patients of male physicians. Understanding differences in resource utilization may offer insights into the care pathways and practice patterns contributing to these differences.
We conducted a population-based, retrospective cohort study of adults (≥18 years of age) undergoing 1 of 25 common surgeries, between January 1, 2007, and December 31, 2019, in Ontario, Canada. The primary outcome was the utilization of one of the following: intensive care unit admission, other medical interventions (eg, tracheostomy, new dialysis starts, and home oxygen), and discharge care needs (eg inpatient rehab, long-term care, and home care use) within 30 days. The data were summarized using descriptive statistics and adjusted using multivariable generalized estimating equations.
This population-based study included 1,100,193 patients (61.8% female). Patients treated by male surgeons had higher use of postoperative resources versus those with female surgeons within 30 days (adjusted rate 33.1; 95% confidence interval [CI]: 28.0-39.2 versus 31.2; 95% CI: 25.8-37.7), 90 days, and 1 year. Consistent with these findings, following adjustment for patient, surgeon, procedural, and hospital characteristics, patients treated by male surgeons were significantly more likely to utilize postoperative resources within 30 days (adjusted odds ratio: 1.14; 95% CI: 1.03-1.27; = 0.010) and at other time points. This difference was primarily driven by the higher use of home care among patients with a male versus female surgeon at all time points (30 days: adjusted odds ratio, 1.13; 95% CI: 1.05-1.21; = 0.002).
Patients with male surgeons had higher postoperative resource utilization when compared with those treated by female surgeons, which was almost entirely driven by the higher use of home care. Further mixed-methods investigation is needed to better understand other potentially relevant factors including surgical outcomes, individual patient preferences, and surgical team decision-making.
确定在加拿大安大略省接受常见手术的患者中，医生性别与术后医疗资源使用之间的关联。
先前的研究表明，与男医生的患者相比，女医生的患者预后更好，医疗成本更低。了解资源利用的差异可能有助于深入了解导致这些差异的护理途径和实践模式。
我们对2007年1月1日至2019年12月31日期间在加拿大安大略省接受25种常见手术之一的成年人（≥18岁）进行了一项基于人群的回顾性队列研究。主要结局是以下情况之一的利用情况：重症监护病房入住、其他医疗干预措施（如气管切开术、开始新的透析治疗和家庭吸氧）以及30天内的出院护理需求（如住院康复、长期护理和家庭护理使用）。数据采用描述性统计进行汇总，并使用多变量广义估计方程进行调整。
这项基于人群的研究纳入了1,100,193名患者（61.8%为女性）。与女外科医生治疗的患者相比，男外科医生治疗的患者在30天内（调整率33.1；95%置信区间[CI]：28.0 - 39.2，而女外科医生为31.2；95% CI：25.8 - 37.7）、90天和1年内术后资源的使用更高。与这些发现一致，在对患者、外科医生、手术程序和医院特征进行调整后，男外科医生治疗的患者在30天内（调整比值比：1.14；95% CI：1.03 - 1.27；P = 0.010）及其他时间点显著更有可能使用术后资源。这种差异主要是由于在所有时间点，男外科医生治疗的患者比女外科医生治疗的患者更多地使用家庭护理（30天：调整比值比，1.13；95% CI：1.05 - 1.21；P = 0.002）。
与女外科医生治疗的患者相比，男外科医生治疗的患者术后资源利用率更高，这几乎完全是由家庭护理的更高使用率所驱动。需要进一步进行混合方法研究，以更好地了解其他潜在相关因素，包括手术结果、患者个人偏好和手术团队决策。
