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Patients treated by female surgeons see better post-operation outcomes

by News Desk

Patients who are operated on by female surgeons have better post-operation outcomes and experience less complications compared to male surgeons, two new studies have found. 

According to separate studies from Canada and Sweden, patients who had been operated on by male surgeon had higher levels of “adverse post-operative events” — ie. medical complications resulting from problems that require further surgery.

The Canadian study, published this week in Jama Surgery, analysed 1.2 million Ontario patients and their medical complications, readmission to hospital, and death rates post -surgery from surgical procedures including on the heart, brain, bones, organs and blood vessels between 2007 and 2019. 

In the study, there were 700 female surgeons and 2,306 male surgeons. 

13.9 per cent of patients treated by male surgeons showed complications that required further treatment 90 days after an operation, whereas 12.5 per cent of patients treated by female surgeons required further treatment. 

The discrepancies existed up to a year after the original operation — 20.7 per cent of patients seen by female surgeons suffered adverse postoperative events a year on, while 25 per cent of those seen by male surgeons experienced complications a year later. 

The death-rates post-surgery are also troublingly distinct — patients operated on by male surgeons were 25 per cent more likely to die 12 months after surgery than those operated on by female surgeons.

The study also found that female patients suffered higher rates of adverse postoperative events within 12 months after being treated by male surgeons.

Heading the Canadian study from his base at Mount Sinai hospital in Toronto, urologic oncologist Dr Christopher Wallis said that the results have led him and his colleagues to “pause and consider why this may be.” He believes that “numerous lessons” must be learned. 

“Men and women differ in how they practise medicine,” he said. “Embracing or adopting some practices that are more common among female physicians is likely to improve outcomes for my patients.”

“Since undertaking this work, I have certainly done this personally and would encourage my colleagues to do the same: use this as a moment for introspection.”

The new study reinforces previous research that found similar findings about patient outcomes related to a surgeon’s sex — though previous studies restricted their analysis to within 30 days of the operation — the standard time period used to examine surgical outcomes. 

Dr Wallis acknowledged that surgeons have become more aware of the lingering effects of surgery for longer than 30 days. 

“Outcomes that are longer are much more about the thought process and the whole overall care pathway delivered to a patient,” he said. “I think that’s why it’s important to complement 30 day outcomes with longer outcomes.”

The study’s co-author Dr Angela Jerath, a cardiac anaesthesiologist at Sunnybrook Health Sciences Centre, noted that despite women forming a smaller subset of the surgeons, “…the patients have been matched in a way that they look as similar as we can make them whether you’re being operated on by a male and female surgeon and you still see this difference.” 

Researchers used statistical modelling techniques to account for differences in patient, surgeon, anesthesiologist, procedure and hospital factors.

Due to limited data, the study could not account for a surgeon’s race and ethnicity, professional hierarchy, years of experience, training, or case complexity. 

In Sweden, Dr My Blohm noted that the general belief that male surgeons are superior to female surgeons is clearly unwarranted. 

“Interestingly, most previously published studies indicate that female surgeons are at least as good as male surgeons, or as in this case even slightly better,” Dr Blohm said. 

Her team at Karolinska Institute in Stockholm analysed over 150,000 patient outcomes after surgery to remove the gallbladder. 

From their investigation of the procedures conducted by over 2,500 surgeons, they found that patients treated by female surgeons experienced fewer complications and had shorter hospital stays than those treated by male surgeons. 

They found that female surgeons operated more slowly than their male colleagues and were less likely to turn a keyhole surgery to an open surgery during an operation.

Both studies suggest female surgeons performed their operations more slowly, thus achieving better results. 

“The fact that female surgeons had operations with fewer complications but longer operation times suggests that the Navy Seal mantra ‘slow is smooth, and smooth is fast’ also applies to surgery,” Swedish Prof Martin Almquist explained in an accompanying editorial. 

Dr Jerath said that a surgeon’s behaviour outside of the operating room is critical to a patient’s recovery. 

Associate professor of surgery at Harvard Medical School, Cassandra Kelleher — who was not involved in the research, agreed. 

“It’s not because females are technically better surgeons,” Dr Kelleher said. “It’s because somehow women are either preparing patients for surgery better, as suggested by their elective patients having better outcomes than emergent patients.”

Dr Kelleher suggested a number of other reasons that patients who are treated by female surgeons face better outcomes — including that they discuss postoperative care alternatives more explicitly to ensure patients adhere to recommendations, and that female surgeons are simply listening to patients more after surgery.

“There’s something qualitatively different about the kind of practice that female surgeons have,” Dr Kelleher said.

“The most poignant point about this [study], I think, is their concluding statement, which is to provide the best patient care, organisations should not only support women physicians but they need to learn how women are accomplishing these better outcomes.”

The Canadian study did not take into account other team members within the operating theatre, including nurses and residents — roles that have an impact on patient care.

Dr Wallis said his team is currently working with “a really skilled anthropologist” to undertake qualitative research observing surgeons “as they interact with their patients and plan patient care to see if we can understand the whys behind these observations.” 

“[Surgery is a] whole continuum of care beginning prior to the decision to operate and continuing long past the conclusion of the operation,” he said. 

In Australia, women surgeons are a minority – studies have shown they make up between 9-13 per cent of surgeons working in the country. A recent study from Monash University has the general surgery workforce at 21 per cent female – though that figure drops to 16 per cent in rural areas.

“Female general surgeons typically work less hours and are less likely to reach leadership roles compared with males, possibly because they are fitting in other life commitments, such as caring roles, and maternity leave,”  Associate Professor Janelle Brennan said this week.

The post Patients treated by female surgeons see better post-operation outcomes appeared first on Women’s Agenda.

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