Surgical Complications More Likely Among Women Operated on by Male Surgeons: Study

The findings of a new study suggest that the risk of surgical complications and readmission to the hospital may be impacted by the genders of the surgeon and patient, with women facing a particularly greater chance of worse outcomes after procedures with male surgeons.

When women have male surgeons, they face a 32% higher risk of dying than if their surgeons were female, according to a study published last month in JAMA Surgery. Male patients did not face the same risks when they had female doctors.

Researchers focused on the effect of sex discordant surgeries among patients, meaning whether having a doctor the same sex as the patient or different sex had any role in outcomes, risk of death or complications, conducting a population-based study of more than 1.3 million adult patients over the age of 18 treated by 2,937 surgeons in Ontario, Canada. Patients were undergoing one of 21 common elective or emergent surgical procedures from 2007 to 2019, including procedures like appendix or gall bladder removal, hip and knee replacements, weight loss surgery, heart bypass, brain surgery, and other procedures.

Roughly half of the patients included in the study were sex concordant with their doctors, meaning a female patient and female doctor or male patient and male doctor. The other half were sex discordant, meaning female patient and male doctor or male patient and female doctor.

According to the findings, women who had male surgeons had a 15% increased risk of having negative outcomes during and after surgery. However, the same was not true for male patients.

Women operated on by male surgeons also had a 32% increased risk of dying during surgery, a 16% increased risk of having major complications and an 11% increased risk of needing to be readmitted to the hospital within 30 days of their surgery. They also had a 20% increased chance of needing to stay in the hospital longer after the initial surgery if their surgeon was male.

Across each type of surgery, women operated on by female surgeons experienced lower rates of complications and death. Researchers speculate “implicit sex biases” may play a role in the difference in complications and death risk. Implicit bias is when surgeons act on subconscious and deeply ingrained biases, stereotypes and attitudes. Other factors may include communication styles, interpersonal skills, judgement, work styles, and conversations patients may have with the doctor before surgery may also play a role.

Overall, nearly 190,000 patients experienced one or more adverse postoperative outcomes. However, the risk was higher for females who had male surgeons than for males who had female surgeons.

Male patients had similar outcomes whether they were operated on by male or female surgeons. But men operated on by male surgeons had an increased risk of death by 13%. This increased risk was not seen among men who were operated on by female surgeons.

Overall, patients who had female doctors fared much better during and after surgery, even after researchers adjusted for chronic health conditions, age, and other factors.

“In this study, sex discordance between surgeons and patients negatively affected outcomes following common procedures,” the researchers wrote. “Subgroup analyses demonstrate that this is driven by worse outcomes among female patients treated by male surgeons. Further work should seek to understand the underlying mechanism.”