Mortality rate after spinal fusion and other surgeries independent of patient-surgeon gender match

Senior author Yusuke Tsugawa (David Geffen School of Medicine) says, "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. Medicine at the University of California Los Angeles [UCLA], Los Angeles, USA). "Given that the difference in patient mortality rates between male and female surgeons is small, patients should consider factors beyond the surgeon's gender when choosing a surgeon.

Gender concordance between patients and physicians (when physician and patient are the same gender) is often linked to higher quality care processes and better patient outcomes through more effective communication, reduced (implicit and explicit) sex and gender bias, and better patient outcomes.

However, as noted in the BMJ's press release, evidence regarding the impact of patient and surgeon gender match on outcomes in patients undergoing surgical procedures is "limited." To address this issue, a team of researchers set out to determine whether patient-surgeon gender concordance was associated with postoperative death in the United States.

Their theory was that patients treated by same-sex surgeons would have a lower postoperative mortality rate than patients treated by gender-nonconforming surgeons. They analyzed data from nearly three million Medicare patients ages 65 to 99 who had one of 14 common major emergency or elective 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.

In this observational study, postoperative mortality was defined as death occurring within 30 days after surgery. Adjustments were made for patient characteristics such as age, race, and underlying conditions; surgeon characteristics such as age, years of practice, and number of surgeries performed; and hospital fixed effects (effective comparison of patients in the same hospital).

Of the 2,902,756 patients who underwent surgery, 1,287,845 (44%) were operated on by surgeons of the same gender (1,201,712 male patients/surgeons (41%) and 86,133 female patients/surgeons (3%)), 1,614. 911 (56%) were performed by surgeons of different genders (52,944 male patients/female surgeons [1.8%] and 1,561,967 female patients/male surgeons [54%]).

For combined emergency and elective procedures, the adjusted mortality rate at 30 days after surgery was 2% in male patients treated by male surgeons, 1.7% in male patients treated by female surgeons, and 1% in female patients treated by male surgeons. 5 and 1.3% in female patients treated by male surgeons. Female patients treated by female surgeons. Additionally, female surgeons had slightly lower patient mortality rates (0.5%) than male surgeons (0.8%) for elective procedures, but no difference in patient mortality was seen for emergency surgeries.

The authors note that several mechanisms may explain this small effect for elective procedures. For example, female surgeons may follow clinical guidelines more than male surgeons or communicate better and pay more attention to postoperative care than male surgeons, which may affect patient mortality rates. They also add that because elective surgeries allow patients to choose their own surgeon, they are more likely to be influenced by other factors than emergency procedures where patients are assigned to on-call surgeons.

The authors note that this was an observational study and therefore cannot be used to determine cause, and also emphasize that other unmeasured social and cultural factors may have influenced the results. They also say their findings may not apply to younger populations, patients undergoing less common procedures, or patients in countries outside the United States.

However, we believe that understanding the mechanisms underlying the events observed in this study "provides an opportunity to improve care processes and models for all patients" They believe.

"Ongoing qualitative and quantitative research will better define how surgeon and patient gender, race, and other aspects of shared identity affect quality of care and postoperative outcomes," the authors write. he adds.