Comparison of Postoperative outcomes Among Patients Treated by Male Versus Female Surgeons: A Systematic Review and Meta-analysis

Natsumi Saka; Norio Yamamoto; Jun Watanabe; Christopher Wallis; Angela Jerath; Hidehiro Someko; Minoru Hayashi; Kyosuke Kamijo; Takashi Ariie; Toshiki Kuno; Hirotaka Kato; Hodan Mohamud; Ashton Chang; Raj Satkunasivam; Yusuke Tsugawa

doi:10.1097/SLA.0000000000006339

Comparison of Postoperative outcomes Among Patients Treated by Male Versus Female Surgeons: A Systematic Review and Meta-analysis

Ann Surg. 2024 May 10. doi: 10.1097/SLA.0000000000006339. Online ahead of print.

Authors

Natsumi Saka^{1

2}, Norio Yamamoto^{2

3}, Jun Watanabe^{2

4

5}, Christopher Wallis^{6

7

8}, Angela Jerath⁹, Hidehiro Someko^{2

10}, Minoru Hayashi^{2

11}, Kyosuke Kamijo^{2

12}, Takashi Ariie^{2

13}, Toshiki Kuno¹⁴, Hirotaka Kato¹⁵, Hodan Mohamud⁶, Ashton Chang⁹, Raj Satkunasivam^{16

17

18}, Yusuke Tsugawa^{19

20}

Affiliations

¹ Department of Orthopedics, Teikyo University School of Medicine, Itabashi, Tokyo, Japan.
² Scientific Research WorkS Peer Support Group (SRWS-PSG), Chuo, Osaka, Japan.
³ Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences. Okayama University, Okayama, Okayama, Japan.
⁴ Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Yakushiji Shimotsuke, Tochigi, Japan.
⁵ Center for Community Medicine, Jichi Medical University, Yakushiji Shimotsuke, Tochigi, Japan.
⁶ Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada.
⁷ Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada.
⁸ Department of Surgical Oncology, University Health Network, Toronto, ON, Canada.
⁹ Department of Anesthesia, Sunnybrook Health Sciences Center, Toronto, ON, Canada.
¹⁰ Department of General Internal Medicine, Asahi General Hospital, Asahi, Chiba, Japan.
¹¹ Department of Emergency Medicine, Fukui Prefectural Hospital, Fukui, Japan.
¹² Department of Gynecology, Nagano Municipal Hospital, Nagano, Japan.
¹³ Department of Physical Therapy, School of Health Sciences, Fukuoka, International University of Health and Welfare, Okawa, Fukuoka, Japan.
¹⁴ Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, USA.
¹⁵ Graduate School of Business Administration, Keio University, Yokohama, Japan.
¹⁶ Department of Urology, Houston Methodist Hospital, Houston, Texas, USA.
¹⁷ Center for Outcomes Research, Houston Methodist Hospital, Houston, Texas, USA.
¹⁸ Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, Texas, USA.
¹⁹ Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
²⁰ Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA.

PMID: 38726676
DOI: 10.1097/SLA.0000000000006339

Abstract

Objective: To compare clinical outcomes of patients treated by female surgeons versus those treated by male surgeons.

Summary background data: It remains unclear as to whether surgical performance and outcomes differ between female and male surgeons.

Methods: We conducted a meta-analysis to compare patients' clinical outcomes-including patients' postoperative mortality, readmission, and complication rates-between female versus male surgeons. MEDLINE, Embase, CENTRAL, ICTRP, and ClinicalTrials.gov were searched from inception to September 8, 2022. The update search was conducted on July 19, 2023. We used random-effects models to synthesize data and GRADE to evaluate the certainty.

Results: A total of 15 retrospective cohort studies provided data on 5,448,121 participants. We found that patients treated by female surgeons experienced a lower post-operative mortality compared with patients treated by male surgeons (8 studies; adjusted odds ratio [aOR], 0.93; 95%CI, 0.88 - 0.97; I2=27%; moderate certainty of the evidence). We found a similar pattern for both elective and non-elective (emergent or urgent) surgeries, although the difference was larger for elective surgeries (test for subgroup difference P=0.003). We found no evidence that female and male surgeons differed for patient readmission (3 studies; aOR, 1.20; 95%CI, 0.83 - 1.74; I2=92%; very low certainty of the evidence) or complication rates (8 studies; aOR, 0.94; 95%CI, 0.88 - 1.01: I2=38%; very low certainty of the evidence).

Conclusions: This systematic review and meta-analysis suggests that patients treated by female surgeons have a lower mortality compared with those treated by male surgeons.