Association of Surgeon-Patient Sex Concordance With Postoperative Outcomes

Abstract

IMPORTANCE Surgeon sex is associated with differential postoperative outcomes, though the mechanism remains unclear. Sex concordance of surgeons and patients may represent a potential mechanism, given prior associations with physician-patient relationships.OBJECTIVE To examine the association between surgeon-patient sex discordance and postoperative outcomes. DESIGN, SETTING, AND PARTICIPANTSIn this population-based, retrospective cohort study, adult patients 18 years and older undergoing one of 21 common elective or emergent surgical procedures in Ontario, Canada, from 2007 to 2019 were analyzed. Data were analyzed from November 2020 to March 2021.EXPOSURES Surgeon-patient sex concordance (male surgeon with male patient, female surgeon with female patient) or discordance (male surgeon with female patient, female surgeon with male patient), operationalized as a binary (discordant vs concordant) and 4-level categorical variable. MAIN OUTCOMES AND MEASURESAdverse postoperative outcome, defined as death, readmission, or complication within 30-day following surgery. Secondary outcomes assessed each of these metrics individually. Generalized estimating equations with clustering at the level of the surgical procedure were used to account for differences between procedures, and subgroup analyses were performed according to procedure, patient, surgeon, and hospital characteristics.RESULTS Among 1 320 108 patients treated by 2937 surgeons, 602 560 patients were sex concordant with their surgeon (male surgeon with male patient, 509 634; female surgeon with female patient, 92 926) while 717 548 were sex discordant (male surgeon with female patient, 667 279; female surgeon with male patient, 50 269). A total of 189 390 patients (14.9%) experienced 1 or more adverse postoperative outcomes. Sex discordance between surgeon and patient was associated with a significant increased likelihood of composite adverse postoperative outcomes (adjusted odds ratio [aOR], 1.07; 95% CI, 1.04-1.09), as well as death (aOR, 1.07; 95% CI, 1.02-1.13), and complications (aOR, 1.09; 95% CI, 1.07-1.11) but not readmission (aOR, 1.02; 95% CI, 0.98-1.07). While associations were consistent across most subgroups, patient sex significantly modified this association, with worse outcomes for female patients treated by male surgeons (compared with female patients treated by female surgeons: aOR, 1.15; 95% CI, 1.10-1.20) but not male patients treated by female surgeons (compared with male patients treated by male surgeons: aOR, 0.99; 95% CI, 0.95-1.03) (P for interaction = .004). CONCLUSIONS AND RELEVANCEIn this study, sex discordance between surgeons and patients negatively affected outcomes following common procedures. 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.

A Woman’s Place Is in Theatre, but Are Theatres Designed with Women in Mind? A Systematic Review of Ergonomics for Women in Surgery

“…Importantly, a more diverse staff also helps patients from minority backgrounds to feel better valued during their hospital stay. In fact, it is not uncommon to observe—because of religious and sociocultural beliefs—challenges for women to be assisted by male doctors or associated staff; therefore, to have an impact on patient health outcomes and quality of life, the care the same patients experience and how they perceive their representation is essential [ 30 , 31 ].…”

A Systematic review of ‘Fair’ AI model development for image classification and prediction

“…Thus, AI models may use learned demographic information for detecting a diagnosis even when such attribute is not associated with the diagnosis. There are examples of race-ethnicity and gender influencing clinician decision-making Wallis et al (2022), and given that AI is trained on real-world data, it is not far-fetch to assume that computers will learn to do the same.…”

Improving Equity, Diversity, and Inclusion in Plastic, Reconstructive, and Aesthetic Surgery in Canada: A Call to Action

“…While female patients treated by male surgeons had worse outcomes (when compared to female patients treated by female surgeons), this effect was not seen with male patients treated by female surgeons (compared to male patients treated by male surgeons). 46…”

“…While female patients treated by male surgeons had worse outcomes (when compared to female patients treated by female surgeons), this effect was not seen with male patients treated by female surgeons (compared to male patients treated by male surgeons). 46 It is clear that more emphasis needs to be placed on promoting and increasing equity and diversity in medicine. As Canadian Plastic, Reconstructive, and Aesthetic surgeons with the privilege of caring for many different diverse populations, it should be our goal to lead by example, developing comprehensive guidelines and educational materials to ensure we are actively listening and learning.…”