Female patients experienced fewer complications post-surgery when operated on by female surgeons, according to the first retrospective population-based study that looked at patient outcomes linked to the sex of the surgeon and sex of the patient.
The Canadian study, which analysed the data of 1.3 million patients in the province of Ontario, found that the small percentage of patients with poor outcomes following surgery fared better when operated on by a female surgeon, and that female patients fared even better than male patients.
Both female and male patients had statistically significant lower rates of death and re-admission to hospital following surgical procedures carried out by female surgeons, but female patients had even lower rates of death and re-admission than male patients when treated by a female surgeon.
“We have demonstrated in our paper that we are failing some female patients and that some are unnecessarily falling through the cracks with adverse and sometimes fatal consequences,” says Dr Angela Jerath, an associate professor and clinical epidemiologist at the University of Toronto and co-author of the study which was published in the medical journal, JAMA Surgery.
Prof Deborah McNamara, consultant general and colorectal surgeon at Beaumont Hospital and clinical professor of surgery at the Royal College of Surgeons of Ireland (RCSI) says that statistically significant findings are not always clinically significant.
“The most alarming figure in the study is that up to 1.7 per cent of patients died a month after surgery but patients can be re-assured that the vast majority of patients do well, as 85 per cent of patients had no adverse outcomes whatsoever,” says Prof McNamara.
She suggests that papers like these are “written to be provocative” and make you ask questions about why the observations were made.
“We can train surgeons to be technical experts but we also need to train surgeons to collaborate and be expert communicators. There is no data in this study about the communication styles of the surgeons yet older male surgeons (those over 61) seem to have better results than younger male surgeons, which makes me wonder if experience is a factor.”
The study which was led by Dr Christopher JD Wallis from the Department of Surgery at the University of Toronto analysed data from almost 3,000 surgeons giving patients their first surgery for one of 21 common surgical procedures (ranging from knee and hip replacement surgery to heart and spinal surgery and removal of the thyroid or appendix) between 2007 and 2019.
Close scrutiny of the data from the study shows that female surgeons have fewer patients overall than their male colleagues. Dr McNamara says that internationally there are fewer female surgeons and that this study also acknowledges that women surgeons were younger and treated younger, healthier patients.
“It’s difficult to look at the findings of this study without looking at the overall context, as low risk and high risk operations are bundled together. Surgeons develop a reputation for dealing with complex operations as their career develops.
“Every surgeon is trying to get the best outcomes for their patients, and a lower case load [among female surgeons] could be a possible explanation for the findings,” she says.
Prof McNamara says that there is “a sweet spot” where surgeons are spending sufficient time doing operations to maintain their skills and expertise and not be under time pressure. “It’s a challenge of professional practice and depends on the team of people around you,” she adds.
Regarding communication styles and patient rapport of male versus female surgeons, Prof McNamara says there are men and women who are good and poor communicators. “The important thing is not to get sidelined by trying to compete but to learn from each other to get the best outcomes.”
She admits, however, that patients benefit when there is more diversity in the profession. “People feel more valued when they see someone like them, and this applies to minority groups as well.”
Female patients may also feel more at ease talking to a female surgeon before their operation and take on board health-promoting behaviours (such as giving up smoking) they can take to improve their chances of a good outcome. Some studies have also shown that patients may report less postoperative pain to male assessors.
Some studies from primary care have found that so-called sex or gender discordance (when the doctor and patient aren’t the same sex/gender) is associated with worse rapport, lower certainty of diagnosis, lower likelihood of assessing the patient’s condition as being of high severity.
