Association of Surgeon Self-Reported Gender and Surgical Outcomes in Current U.S. Practice

Author:

Scali Salvatore T.1,Columbo Jesse A.2,Hawn Mary T.3,Mitchell Erica L.4,Neal Dan1,Wong Sandra L.5,Huber Thomas S.1,Upchurch Gilbert R.16,Stone David H.2

Affiliation:

1. Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville

2. Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH

3. Department of Surgery, Stanford University, Palo Alto, CA

4. Division of Vascular Surgery, University of Tennessee Health & Science Center, Memphis, TN

5. Emory University School of Medicine, Atlanta, GA

6. Department of Surgery, University of Florida, Gainesville

Abstract

Objective: This study aimed to evaluate the association of surgeon self-reported gender on clinical outcomes in contemporary U.S. surgical practice. Summary Background Data: Previous research has suggested that there are potentially improved surgical outcomes for female surgeons, yet the underlying causal path for this association remains unclear. Methods: Using the Vizient® Clinical Database(2016-2021), 39 operations categorized by the CDC’s National Healthcare Safety Network were analyzed. Surgeon self-reported gender was the primary exposure. The primary outcome was a composite of in-hospital death, complications, and/or 30-day readmission. Multivariable logistic regression and propensity score matching was used for risk adjustment. Results: The analysis included 4,882,784 patients operated on by 11,955 female surgeons(33% of surgeons, performing 21% of procedures) and 23,799 male surgeons(67% of surgeons, performing 79% of procedures). Female surgeons were younger(45±9 vs. males-53±11 y;P<0.0001) and had lower operative volumes. Unadjusted incidence of the primary outcome was 13.6%(10.7%-female surgeons, 14.3%-male surgeons;P<0.0001). After propensity matching, the primary outcome occurred in 13.0% of patients(12.9%-female, 13.0%-male; OR[M vs. F]=1.02, 95%CI 1.01-1.03;P=.001), with female surgeons having small statistical associations with lower mortality and complication rates but not readmissions. Procedure-specific analyses revealed inconsistent or no surgeon-gender associations. Conclusions: In the largest analysis to date, surgeon self-reported gender had a small statistical, clinically marginal correlation with postoperative outcomes. The variation across surgical specialties and procedures suggests that the association with surgeon gender is unlikely causal for the observed differences in outcomes. Patients should be reassured that surgeon gender alone does not have a clinically meaningful impact on their outcome.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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