Impact of surgeon and anaesthesiologist sex on patient outcomes after cardiac surgery: a population-based study

Abstract

BackgroundEffective teamwork between anaesthesiologists and surgeons is essential for optimising patient safety in the cardiac operating room. While many factors may influence the relationship between these two physicians, the role of sex and gender have yet to be investigated.ObjectivesWe sought to determine the association between cardiac physician team sex discordance and patient outcomes.DesignWe performed a population-based, retrospective cohort study.Participants and settingAdult patients who underwent coronary artery bypass grafting (CABG) and/or aortic, mitral or tricuspid valve surgery between 2008 and 2018 in Ontario, Canada.Primary and secondary outcome measuresThe primary outcome was all-cause 30-day mortality. Secondary outcomes included major adverse cardiovascular events at 30 days and hospital and intensive care unit lengths of stay (LOS). Mixed effects logistic regression was used for categorical outcomes and Poisson regression for continuous outcomes.Results79 862 patients underwent cardiac surgery by 98 surgeons (11.2% female) and 279 anaesthesiologists (23.3% female); 19 893 (24.9%) were treated by sex-discordant physician teams. Physician sex discordance was not associated with overall patient mortality or LOS; however, patients who underwent isolated CABG experienced longer hospital LOS when treated by an all-male physician team as compared with an all-female team (adjusted OR=1.07; p=0.049). When examining the impact of individual physician sex, the length of hospital stay was longer when isolated CABG procedures were attended by a male surgeon (OR=1.10; p=0.004) or anaesthesiologist (OR=1.02; p=0.01).ConclusionsPatient mortality and length of stay after cardiac surgery may vary by sex concordance of the attending surgeon–anaesthesiologist team. Further research is needed to examine the underlying mechanisms of these observed relationships.

Factors and Priorities Influencing Satisfaction with Care among Women Living with HIV in Canada: A Fuzzy Cognitive Mapping Study

“…The importance of patient-provider relationships, including those developed with female healthcare providers, has been shown to affect health outcomes, such as discussing reproductive goals with healthcare providers and sexual and perinatal wellbeing among women living with HIV [ 12 , 36 ]. Healthcare provider gender has been shown to predict health outcomes outside of HIV care [ 37 , 38 ]. Women living with HIV who have good relationships with their care providers may be more likely to remain engaged in and feel safe, supported, and satisfied with their HIV care.…”

Is self-advocacy universally achievable for patients? The experiences of Australian women with cardiac disease in pregnancy and postpartum

“…Research demonstrates that women’s cardiac outcomes are poorer if there is a physician-patient gender discordance (Lau et al, 2021 ). In contrast, Sun et al ( 2021 ) found no gender discordance difference in length of stay or mortality but that female patients with a female surgeon (or a female surgeon and anaesthetist dyad) had shorter lengths of stay, confirming findings by Greenwood et al ( 2018 ) that male physicians treating female patients was associated with poorer outcomes, not gender discordance per se. Education is recommended for healthcare professionals and for women to be empowered to self-advocate, however it is critical to ensure women do not experience negative fall-out if their efforts in self-advocating develop faster than education and cultural changes within which they seek care (Stehli et al, 2021 ).…”

Derivation and validation of pragmatic clinical models to predict hospital length of stay after cardiac surgery in Ontario, Canada: a population-based cohort study

“…Ontario is the most populous province in Canada, with about 14.6 million residents, and is ethnically diverse. 10 Ontario operates a publicly funded health care system that reimburses all covered services and clinicians. All centres in Ontario performing cardiac surgical procedures were included.…”

“…21,23,29,30 Frailty is defined by the Hospital Frailty Risk Score, a multidimensional frailty instrument that was validated using routinely collected hospital admissions data of patients aged 75 years or older from the United Kingdom. 31,32 This score ranges between 0 and 173.1 points and is stratified by low risk (< 5), intermediate risk [3][4][5][6][7][8][9][10][11][12][13] and high risk (> 15). 31…”