Does patient-surgeon gender concordance lead to lower patient mortality? Mostly no, UCLA-led research suggests
New research finds little evidence that post-surgical patient mortality is lower when patient and surgeon are the same gender.
While gender concordance has been shown to improve patient care in other health specialties, evidence has been limited when it comes to concordance between patient and surgeon. This study shows that gender concordance was associated with lower mortality for female patients, but higher mortality for male patients—patient mortality was the lowest for female patients treated by female surgeons, and the highest for male patients treated by male surgeons.
This study also investigated the impact of surgeon gender, and shows that female surgeons had slightly lower patient mortality than males for elective surgeries, but no gender difference for non-elective procedures.
The findings will be published in the peer-reviewed journal The BMJ.
“It is important for patients to know that the quality of surgical care provided by female surgeons in the United States is equivalent to, or in some cases, slightly better than that provided by male surgeons,” said senior author Dr. Yusuke Tsugawa, associate professor of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA. “Given that the difference in patient mortality between female and male surgeons was small, when choosing a surgeon, patients should take into account factors beyond the gender of the surgeon.”
The researchers examined data for 2.9 million Medicare fee-for-service beneficiaries aged 65 years and older who underwent one of 14 surgeries between 2016 and 2019: abdominal aortic aneurysm repair, appendectomy, cholecystectomy, colectomy, coronary artery bypass surgery, knee replacement, hip replacement, hysterectomy, laminectomy or spinal fusion, liver resection, lung resection, prostatectomy, radical cystectomy, and thyroidectomy.
Of the participants, 1.2 million (41%) were male surgeon/patient pairs, 86,000 (3%) were female pairs, and 1.6 million (56%) were pairs of different genders (52,000, or 1.8%, were male patient/female surgeon and 1.5 million, or 54%, female patient/male surgeon). The outcome measure was death within 30 days of the procedure.
Adjusting for patient and surgeon characteristics and other factors, the researchers found that 30 day post-surgery mortality was 2.0% for male patient-male surgeon, 1.7% for male patient-female surgeon, 1.5% for female patient-male surgeon, and 1.3% for female patient-female surgeon pairs.
Study limitations include potential undetected confounders from Medicare claims data, an inability to account for contributory characteristics of other healthcare team members, and the possibility that the findings may not apply to younger patients.
But the findings could lead to a better understanding of processes that improve care for all patients, the researchers write. “Ongoing qualitative and quantitative research will better delineate how surgeon and patient gender, along with race and other aspects of shared identity, affect quality of care and outcomes after surgery,” they write.
Study co-authors are Ryo Ikesu, Dr. Melinda Maggard-Gibbons, and Ruixin Li of UCLA; Christopher Wallis, Angela Jerath, Dr. Natalie Coburn, and Allan Detsky, of the University of Toronto; Raj Satkunasivam of Texas A&M University and Houston Methodist Hospital; Justin Dimick of University of Michigan; E. John Orav of Harvard University; Arghavan Salles of Stanford University; Zachary Klaassen of Georgia-Augusta University, and Barbara Bass of George Washington University.
This study was funded by the National Institute of Health (NIH)/National Institute on Minority Health and Health Disparities (R01 MD013913) and Gregory Annenberg Weingarten GRoW @Annenberg.
Does patient-surgeon gender concordance lead to lower patient mortality? Mostly no, UCLA-led research suggests
New research finds little evidence that post-surgical patient mortality is lower when patient and surgeon are the same gender.
While gender concordance has been shown to improve patient care in other health specialties, evidence has been limited when it comes to concordance between patient and surgeon. This study shows that gender concordance was associated with lower mortality for female patients, but higher mortality for male patients—patient mortality was the lowest for female patients treated by female surgeons, and the highest for male patients treated by male surgeons.
This study also investigated the impact of surgeon gender, and shows that female surgeons had slightly lower patient mortality than males for elective surgeries, but no gender difference for non-elective procedures.
The findings will be published in the peer-reviewed journal The BMJ.
“It is important for patients to know that the quality of surgical care provided by female surgeons in the United States is equivalent to, or in some cases, slightly better than that provided by male surgeons,” said senior author Dr. Yusuke Tsugawa, associate professor of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA. “Given that the difference in patient mortality between female and male surgeons was small, when choosing a surgeon, patients should take into account factors beyond the gender of the surgeon.”
The researchers examined data for 2.9 million Medicare fee-for-service beneficiaries aged 65 years and older who underwent one of 14 surgeries between 2016 and 2019: abdominal aortic aneurysm repair, appendectomy, cholecystectomy, colectomy, coronary artery bypass surgery, knee replacement, hip replacement, hysterectomy, laminectomy or spinal fusion, liver resection, lung resection, prostatectomy, radical cystectomy, and thyroidectomy.
Of the participants, 1.2 million (41%) were male surgeon/patient pairs, 86,000 (3%) were female pairs, and 1.6 million (56%) were pairs of different genders (52,000, or 1.8%, were male patient/female surgeon and 1.5 million, or 54%, female patient/male surgeon). The outcome measure was death within 30 days of the procedure.
Adjusting for patient and surgeon characteristics and other factors, the researchers found that 30 day post-surgery mortality was 2.0% for male patient-male surgeon, 1.7% for male patient-female surgeon, 1.5% for female patient-male surgeon, and 1.3% for female patient-female surgeon pairs.
Study limitations include potential undetected confounders from Medicare claims data, an inability to account for contributory characteristics of other healthcare team members, and the possibility that the findings may not apply to younger patients.
But the findings could lead to a better understanding of processes that improve care for all patients, the researchers write. “Ongoing qualitative and quantitative research will better delineate how surgeon and patient gender, along with race and other aspects of shared identity, affect quality of care and outcomes after surgery,” they write.
Study co-authors are Ryo Ikesu, Dr. Melinda Maggard-Gibbons, and Ruixin Li of UCLA; Christopher Wallis, Angela Jerath, Dr. Natalie Coburn, and Allan Detsky, of the University of Toronto; Raj Satkunasivam of Texas A&M University and Houston Methodist Hospital; Justin Dimick of University of Michigan; E. John Orav of Harvard University; Arghavan Salles of Stanford University; Zachary Klaassen of Georgia-Augusta University, and Barbara Bass of George Washington University.
This study was funded by the National Institute of Health (NIH)/National Institute on Minority Health and Health Disparities (R01 MD013913) and Gregory Annenberg Weingarten GRoW @Annenberg.
METHOD OF RESEARCH
Observational study
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Association between patient-surgeon gender concordance and mortality after surgery in the United States: retrospective observational study
ARTICLE PUBLICATION DATE
22-Nov-2023
Death rates after major surgery are similar regardless of whether a male or female surgeon operates on a male or female patient, finds a large US study published by The BMJ today.
The differences seen were small and not clinically meaningful and the researchers say their findings should help improve processes and patterns of care for all patients.
Gender concordance between patients and physicians (when the physician and patient are of the same sex) is generally linked to higher quality care processes and improved patient outcomes through more effective communication, reduced (implicit and explicit) sex and gender bias, and better rapport.
But evidence is limited about the effect of patient and surgeon gender concordance on outcomes of patients undergoing a surgical procedure.
To address this, researchers set out to determine whether patient-surgeon gender concordance is associated with death after surgery in the United States.
Their theory was that patients treated by surgeons of the same gender would have a lower postoperative death rate than patients treated by gender discordant surgeons.
They analysed data for almost 3 million Medicare patients aged 65-99 years who underwent one of 14 common major urgent or non-urgent (elective) surgeries between 2016 and 2019 including coronary artery bypass surgery, knee or hip replacement, hysterectomy, liver or lung resection, and thyroidectomy.
Death after surgery was defined as death within 30 days of the operation.
Adjustments were made for patient characteristics (such as age, race and underlying conditions), surgeon characteristics (such as age, years in practice and number of operations performed) and hospital fixed effects (effectively comparing patients within the same hospital).
Of 2,902,756 patients who had surgery, 1,287,845 (44%) had operations done by surgeons of the same gender (1,201,712 (41%) male patient and male surgeon and 86,133 (3%) female patient and female surgeon) and 1,614,911 (56%) were by surgeons of different gender (52,944 (1.8%) male patient and female surgeon and 1,561,967 (54%) female patient and male surgeon).
For urgent and elective procedures combined, the adjusted death rate 30 days after surgery was 2% for male patients treated by male surgeons, 1.7% for male patients treated by female surgeons, 1.5% for female patients treated by male surgeons, and 1.3% for female patients treated by female surgeons.
For elective procedures, female surgeons had slightly lower patient death rates (0.5%) than male surgeons (0.8%), whereas no difference in patient mortality was seen for urgent surgeries.
Several mechanisms could explain this small effect for elective procedures, say the authors. For example, female surgeons may abide by clinical guidelines more than male surgeons, or might have better communication and increased attention to postoperative care than male surgeons, which could affect patient death rates.
What’s more, as elective surgeries allow patients to choose their own surgeon, they are more prone to influence from other factors compared with urgent procedures where patients are assigned to on-call surgeons, they add.
This is an observational study, so can’t establish cause, and the researchers stress that other unmeasured social and cultural factors may have influenced their results. What’s more, they say their findings may not apply to younger populations, patients who receive less common procedures, or patients in other countries.
Nevertheless, they say understanding the underlying mechanisms of this observation “allows the opportunity to improve processes and patterns of care for all patients.”
They add: “Ongoing qualitative and quantitative research will better delineate how surgeon and patient gender, along with race and other aspects of shared identity, affect quality of care and outcomes after surgery.”
METHOD OF RESEARCH
Observational study
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Association between patient-surgeon gender concordance and mortality after surgery in the United States: retrospective observational study
ARTICLE PUBLICATION DATE
22-Nov-2023
COI STATEMENT
All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare: support from the National Institute on Minority Health and Health Disparities and Gregory Annenberg Weingarten GRoW @Annenberg for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work
