Examining Gender Disparities Among Physicians When Sample Sizes Differ

Abstract

To the Editor We read with interest the recent publication by Wallis and colleagues. 1 There are several mismatches between the male-female groups, which support that the reported outcome differences in mortality, readmission, and complication rate might be the result of male surgeons having performed more complex surgeries (high complexity: male surgeons = 65.7%; female surgeons = 59.5%) on older patients (mean patient age: male surgeons = 60 years; female surgeon = 52.5 years) with more serious medical problems (comorbidity aggregate disease group ≥11: male surgeons = 20.3%; female surgeons = 17.7%).Wallis et al 1 included 12.2 times more male than female orthopedic surgeons who performed 29.5 times the number of surgeries, creating an overrepresentation in the male cohort of patients with femoral fracture, who are associated with a high complication rate. Haugan et al 2 reported a 90-day and 1-year mortality rate of 13.8% and 25.9%, respectively, and a 90-day and 1-year readmission rate of 23.7% and 39.8%, respectively, after hip fracture surgery.Boukebous et al 3 reported that 77% of patients with hip fracture were female, which possibly explains why Wallis et al 1 identified that female emergent cases had significantly higher rates of adverse postoperative events when treated by male surgeons, because of the overrepresentation and high mortality and readmission rate of femoral fracture patients, rather than being linked to the sex of the surgeon.Wallis et al 1 included 15.8 times more male than female neurosurgeons, but male neurosurgeons performed 19.6 times the number of surgeries. This imbalance creates further bias against male surgeons, considering the high surgical mortality rate for nonelective surgeries and high readmission rates in this specialty. Donoho et al 4 reported 30-and 90-day readmission rates after craniotomy for malignant brain tumors of 13.2% and 25.7%, respectively, excluding planned readmissions for chemotherapy. Wallis et al 1 did not identify how many of the readmissions were planned and not due to an adverse event.