Female surgeons may take a little longer, but you’re more likely to leave intact, spend less time in hospital and not need to come back.
Last week my Back Page colleague told you about the deficit of female doctors in movies.
Screen humans are missing out, then, as it seems female physicians and surgeons deliver better outcomes for patients.
Two new papers in JAMA Surgery set out to build on previous studies suggesting this, including a Canadian one that found surgeries by women resulted in less mortality and fewer readmissions and complications at 30 days post-procedure; and a Japanese one that found no difference in outcomes even though female surgeons did fewer laparoscopic procedures and operated on a higher proportion of high-risk patients.
This massive retrospective cohort study involving 1.1 million patients undergoing various surgeries in Ontario built upon the 30-day study and found that, adjusting for patient, procedure, surgeon, anaesthesiologist and hospital characteristics, “patients treated by female surgeons have lower rates of adverse postoperative outcomes including death at 90 days and 1 year after surgery compared with those treated by male surgeons”.
The second, also large, study by a different team used a Swedish database to analyse the effect of surgeon gender (rather than biological sex) on complications and injuries during elective and acute cholecystectomies, as well as length of hospital stay and duration of procedure. They found female surgeons operated more slowly and their patients had significantly fewer adverse outcomes and shorter hospital stays.
The odds ratio, if you enjoy those, for cholecystectomy complications (including bleeding, visceral perforation, bile duct injury, post-operative bile leakage and abscesses) after male-performed elective surgeries was 1.39 (CI 1.25-1.54), one of the larger effect sizes across the two studies.
This chimes, the authors say, with a systematic review that found female med students were slower but had higher precision.
The question for the patient then becomes, do you want to get out of there faster or with your viscera unperforated?
Then there is the why.
The authors of the Canadia study say previous work has found differences in communication, practice style, and the physician-patient relationship between female and male physicians.
Female patients are the biggest beneficiaries of having a female surgeon.
The Back Page was prepared to read that women have to work harder and more conscientiously to be regarded as equal to their male peers – running to stand still – but these authors think something additional is going on.
Prior work has also reported “that female surgeons undertake additional efforts (termed a status-levelling burden) within the context of the health care ecosystem to address challenges within the profession and these additional efforts may translate to patient outcomes”.
Status-levelling burden is a new term to the Back Page, and seems to mean that high-status women in male-dominated professions experience pressure to appear equal with lower-status women in order to gain their co-operation. We’ll continue to puzzle over how that fits here.
The authors of the Swedish study, in interpreting their findings, cite previous work finding female physicians adhere to guidelines more closely, “use more patient-centered communication, are more willing to collaborate, and select patients for planned surgery more carefully … This study’s important finding that female surgeons may perform safer operations and operate more slowly indicates that caution might be a favourable quality. However, it is important to highlight that competitive and risk-taking behaviours are also seen among female surgeons.”
They note that lack of mentorship is one reason women quit surgery as a speciality, and that despite their better results, “women continue to be marginalised in the workplace in many ways. To provide the best patient care, organisations should support women physicians and learn how they accomplish these improved outcomes.”
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