Do female surgeons have better patient outcomes?
Two fascinating studies on healthcare outcomes came out this week comparing post-operative complication rates for male and female surgeons.
One study looked at data from nearly 1.2 million patients over a 13 period in Canada, and found 8% higher complication rates 90 days after surgery and 6% higher complications rates 1 year after surgery for male surgeons compared with female surgeons. Significantly there was 25% higher mortality at 90 days and 1 year for male surgeons. This study looked at a range of different surgical specialties including cardiothoracic, general, orthopaedic, plastic and vascular surgery. There was no association between surgeon sex and patient outcomes for male patients, but female patients had a higher rate of adverse post-operative events when they were treated by male surgeons.
The second study looked at data from 150,000 patients over 14 years in Sweden. Patients operated on by a male surgeon had 29% higher rates of surgical complications and 12% higher general complications. Female surgeons had significantly longer operation times, whilst male surgeons moved from keyhole to open surgery more often, and their patients had longer hospital stays.
These studies build on the evidence that suggests that patients treated by female physicians have better outcomes than those treated by male physicians and point to the need for further research to understand why. There are inevitable limitations with research like this, particularly the difficulties in overcoming confounding and the retrospective observational study design. But there are important strengths, particularly in the size of the population-based datasets and the robust analysis. The fact that there is consistency in the results from the two studies also supports the conclusions.
Some of the commentary about the studies has been interesting. There has been pushback from male surgeons pointing to differences in the complexity of cases as the most likely explanation for the different outcomes. Whilst it is important to ensure that evidence guiding practice is robust, it is also important to engage constructively with evidence as it emerges – what is it about female clinicians that leads to better outcomes. As one of the study authors, Dr Christopher Walls, noted:
‘As a male surgeon, I think these data should cause me and my colleagues to pause and consider why this may be.’
There is clearly an opportunity here to reflect and learn from these studies to improve patient outcomes.
I’ll leave you with an interesting thought experiment – imagine if the results were the opposite. What would be the reaction if a large study showed that female surgeons had poorer outcomes, and a 25% higher mortality rate than male surgeons? Would we dismiss the results so readily on the basis of complexity of cases or other confounding factors, or would we be more inclined to accept the results and make judgements on the competence of female surgeons?