https://www.theguardian.com/society/202 ... geon-study
Abstract:They found that for women, treatment by a male surgeon was associated with a 15% increased likelihood of a poor outcome than if they were treated by a female surgeon. However, men experienced no differences whether they were treated by a male or female surgeon.
Similarly, women who were operated on by a male surgeon had a 32% higher risk of death than those whose surgery had been performed by a woman. For example, while 1.4% of women who had a cardiothoracic operation with a male surgeon died, fewer – 1% – did so when a female surgeon was involved. In both brain surgery and vascular surgery, while 1.2% of women who underwent either type of operation with a male surgeon died, again that proportion was much lower among those whose surgeon was female – 0.9% – giving a 33% higher risk of death.
Overall, female patients also had a 16% greater risk of complications and an 11% greater risk of readmission and were 20% more likely to have to stay in hospital longer.
Women had a higher risk of death, readmission or complications when a man performed the operation across many of the 21 types of surgery analysed.
For example, while 20.2% of women who had cardiothoracic (chest) surgery by a male surgeon suffered some form of adverse reaction, a lower percentage – 18% – did so if their surgeon was female. The same pattern was seen in general surgery, brain surgery and orthopaedic surgery.
Technical differences between male and female surgeons are unlikely to explain the findings “as both sexes undergo the same technical medical training”, said Jerath.
“Implicit sex biases”, in which surgeons “act on subconscious, deeply ingrained biases, stereotypes and attitudes”, may be one possible explanation, she said. Differences in men’s and women’s communication and interpersonal skills evident in surgeons’ discussions with patients before the operation takes place may also be a factor, she added. And “differences between male and female physician work style, decision-making and judgment”.
Fiona Myint, the vice-president of the Royal College of Surgeons of England, highlighted that 86% of consultant (senior) surgeons in Britain were men.
https://jamanetwork.com/journals/jamasu ... .2021.6339
Results Among 1 320 108 patients treated by 2937 surgeons, 602 560 patients were sex concordant with their surgeon (male surgeon with male patient, 509 634; female surgeon with female patient, 92 926) while 717 548 were sex discordant (male surgeon with female patient, 667 279; female surgeon with male patient, 50 269). A total of 189 390 patients (14.9%) experienced 1 or more adverse postoperative outcomes. Sex discordance between surgeon and patient was associated with a significant increased likelihood of composite adverse postoperative outcomes (adjusted odds ratio [aOR], 1.07; 95% CI, 1.04-1.09), as well as death (aOR, 1.07; 95% CI, 1.02-1.13), and complications (aOR, 1.09; 95% CI, 1.07-1.11) but not readmission (aOR, 1.02; 95% CI, 0.98-1.07). While associations were consistent across most subgroups, patient sex significantly modified this association, with worse outcomes for female patients treated by male surgeons (compared with female patients treated by female surgeons: aOR, 1.15; 95% CI, 1.10-1.20) but not male patients treated by female surgeons (compared with male patients treated by male surgeons: aOR, 0.99; 95% CI, 0.95-1.03) (P for interaction = .004).
Link: https://ps-vascular.ch/wp-content/uploa ... tcomes.pdf
The statistical methods don't seem very complicated, so I would be surprised if there is a subtle hidden stats error. (I will note that Odds Ratio is not the same as Relative Risk, and Relative Risk is not the same as Absolute Risk, but I don't think either issue is significant here).
My qualitative research buddy proposes to me (quite frequently...) that the numbers can tell you what happens, but not why it happens. Although the authors make various suggestions, I would really value any comments or suggestions from forum members. It could make a difference to how I go about the day job.
There are similar studies out there.
Same lead author:
Wallis, C.J., Ravi, B., Coburn, N., Nam, R.K., Detsky, A.S. and Satkunasivam, R., 2017. Comparison of postoperative outcomes among patients treated by male and female surgeons: a population based matched cohort study. Bmj, 359.
Results 104 630 patients were treated by 3314 surgeons, 774 female and 2540 male. Before matching, patients treated by female doctors were more likely to be female and younger but had similar comorbidity, income, rurality, and year of surgery. After matching, the groups were comparable. Fewer patients treated by female surgeons died, were readmitted to hospital, or had complications within 30 days (5810 of 52 315, 11.1%, 95% confidence interval 10.9% to 11.4%) than those treated by male surgeons (6046 of 52 315, 11.6%, 11.3% to 11.8%; adjusted odds ratio 0.96, 0.92 to 0.99, P=0.02). Patients treated by female surgeons were less likely to die within 30 days (adjusted odds ratio 0.88; 0.79 to 0.99, P=0.04), but there was no significant difference in readmissions or complications. Stratified analyses by patient, physician, and hospital characteristics did not significant modify the effect of surgeon sex on outcome. A retrospective analysis showed no difference in outcomes by surgeon sex in patients who had emergency surgery, where patients do not usually choose their surgeon.
Hospital medicine rather than surgery:
Tsugawa, Y., Jena, A.B., Figueroa, J.F., Orav, E.J., Blumenthal, D.M. and Jha, A.K., 2017. Comparison of hospital mortality and readmission rates for Medicare patients treated by male vs female physicians. JAMA internal medicine, 177(2), pp.206-213.
Greenwood, B.N., Carnahan, S. and Huang, L., 2018. Patient–physician gender concordance and increased mortality among female heart attack patients. Proceedings of the National Academy of Sciences, 115(34), pp.8569-8574.Findings In this cross-sectional study, we examined nationally representative data of hospitalized Medicare beneficiaries and found that patients treated by female physicians had significantly lower mortality rates (adjusted mortality rate, 11.07% vs 11.49%) and readmission rates (adjusted readmission rate, 15.02% vs 15.57%) compared with those cared for by male physicians within the same hospital.
We examine patient gender disparities in survival rates following acute myocardial infarctions (i.e., heart attacks) based on the gender of the treating physician. Using a census of heart attack patients admitted to Florida hospitals between 1991 and 2010, we find higher mortality among female patients who are treated by male physicians. Male patients and female patients experience similar outcomes when treated by female physicians, suggesting that unique challenges arise when male physicians treat female patients. We further find that male physicians with more exposure to female patients and female physicians have more success treating female patients.