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Women 32% more likely to die after operation by male surgeon, study reveals.


Women operated on by a male surgeon are far more likely to die, experience complications and be readmitted to hospital than when a woman performs the procedure, according to new research.

Women are 15% more liable to suffer a bad outcome, and 32% more likely to die, when a man, rather than a woman, carries out the surgery, according to a study of 1.3m patients.

The findings, published in the medical journal JAMA Surgery, have renewed debate about UK surgery being male-dominated and claims that an “implicit sex biases” among male surgeons may explain why women are at greater risk when operated upon.

Associate professor and clinical epidemiologist at University of Toronto, Canada, and co-author of the findings, Dr Angela Jerath, said: “Our 1.3m patient sample, involving nearly 3,000 surgeons, found that women treated by men had 15% greater chance of worse results than those treated by a woman with more complications, hospital readmissions and deaths compared with males.

“Our paper demonstrates that we are failing some female patients who are unnecessarily falling through the cracks with adverse, and sometimes fatal, consequences which is concerning because there should be no difference in patient outcomes regardless of the surgeon’s sex.

“The results are troubling. When a female surgeon operates, patient outcomes are generally better, particularly for women, even after adjusting for differences in chronic health status, age and other factors, when undergoing the same procedures.”

Jerath and her colleagues analysed records of 1,320,108 Ontario patients after 21 surgical procedures by 2,937 surgeons between 2007 and 2019, ranging from hip and knee replacements and weight loss surgery to appendix or gall bladder removal and more complex procedures such as a heart bypass, aneurysm repair and brain surgery. They also analysed the gender of each patient, their post surgery progress and the surgeon’s gender.

They found that men who had an operation had the same outcomes regardless of whether their surgeon was male or female. However, women experienced better outcomes if a female, rather than a male, surgeon carried out the procedure. There were no gender differences in how surgery went for either men or women operated on by a female surgeon.

Dr Jerath added that while “there are some excellent male surgeons who consistently have good outcomes, this analysis signals some real differences among male and female surgeons in general patient outcomes.”

The study was the first to examine links between patient and surgeon genders and the results of surgery, such as death, hospital readmissions and complications within 30 days.

They found that for women, treatment by a man was associated with a 15% increased likelihood of a poor outcome than if they were treated by a woman surgeon. However, men experienced no differences whether looked after by a male or female surgeon.

Similarly, women operated on by a male surgeon had a 32% higher risk of death than those whose surgery was performed by a woman. For example, while 1.4% of women who had a cardiothoracic operation with a male surgeon died, fewer – 1% – did so when a female surgeon was involved.

In both brain surgery and vascular surgery, while 1.2% of women who underwent either type of operation with a male surgeon died, that proportion was much lower among those whose surgeon was female – 0.9% – giving a 33% higher risk of death.

Overall, female patients had a 16% greater risk of complications and an 11% greater risk of readmission and were 20% more likely to have to stay in hospital longer.

Women had a higher risk of death, readmission or complications when a man performed the operation across many of the 21 types of surgery analysed.

For example, while 20.2% of women who had cardiothoracic (chest) surgery by a male surgeon suffered some form of adverse reaction, a lower percentage – 18% – did so if their surgeon was female. The same pattern was seen in general surgery, brain surgery and orthopaedic surgery.

Dr Jerath said that technical differences between male and female surgeons are unlikely to explain the findings as men and women undergo the same technical medical training, “implicit sex biases”, in which surgeons “act on subconscious, deeply ingrained biases, stereotypes and attitudes”, may be one possible explanation.

Differences in male and female communication and interpersonal skills, evident in surgeons’ discussions with patients before the operation takes place, may also be a factor, she added, along with “differences between male and female physician work style, decision-making and judgment.”

Vice-president of the Royal College of Surgeons of England, Fiona Myint, highlighted that 86% of consultant (senior) surgeons in Britain were men.

She said: “Surgery is still a long way from having a gender balance in its workforce. Women make up 41% of early stage surgeons but only 30% of higher trainees and 14% of consultants.

Parenthood, “a lack of flexibility in surgical training schedules and rotas” and “negative attitudes to less than full-time training” all explain why many women do not become consultant surgeons, she added.

A consultant orthopaedic surgeon for 20 years, Scarlett McNally, said there was “increasing evidence of a different experience for women surgeons, with many being put off surgery and reporting historical ‘micro-aggressions’.”

Also, women patients may feel more at ease talking to a female surgeon before the operation, including steps they should take to improve their chances of a good outcome, such as stopping smoking to help ensure a successful bone graft, she added.

McNally also cited “unconscious bias” – assumptions among senior surgeons, nurses, administrators and patients that female medical students or young doctors will not want to pursue a career in surgery – as a factor.

She said: “Having more female surgeons would improve all patients’ outcomes.”

The Royal College of Surgeons of England said the findings were “interesting. Much more detailed research is required looking at communication, trust and doctor-patient relationships.”