- Female patients treated by male surgeons more commonly experience post-operative complications and death than when treated by female surgeons. (Wallis 2021)
- Care from male surgeons and/or anaesthesiologists is associated with longer lengths of stay after cardiac surgery. (Sun 2021)
- Female heart-attack patients are less likely to survive when treated by a male physician than a female physician. (Greenwood 2018)
- Treatment from female surgeons is associated with a lower 30 day mortality than the same from male surgeons. (Wallis 2017)
- In-patient care from a female physician is associated with lower 30 day mortality and readmission rate among elderly patients. (Tsugawa 2017)
For patients undergoing coronary artery bypass grafting there is no mortality difference between volatile anaesthesia and TIVA.
File under correlation-is-not-causation-but...
Sometimes even correlations are too significant and important to just be fobbed off by epidemiological cliché. This collection contains articles repeatedly showing association between doctor characteristics, particularly gender, and patient outcome.
Although most recently shown by Wallis in JAMA Surgery (2021), gender-outcome associations are depressingly not new.
The cause of this gender outcome disparity is unclear, and importantly these studies are hypothesis forming, rather than proving. Nonetheless both Wallis (2021) and Greenwood (2018) hint at causes, namely a lack of experience treating female patients for some male doctors, and consequential lesser understanding of gender-disease differences.
The temptation when attempting to understand this is to descend into medical gender essentialism – ironically, probably a contributor to the actual outcome disparities.
A similar doctor-outcome disparity is seen with age. Among physicians, care from older doctors was associated with worse outcomes (Tsugawa 2017), yet for surgeons older age conferred better outcomes (Tsugawa 2018; Satkunasivam 2020). Causes here are possibly a nexus between experience, up-to-date knowledge and work volume – but also, still unclear.
Patient post-operative mortality was lowest for those treated by older surgeons.
In-patient care from a female physician is associated with lower 30 day mortality and readmission rate among elderly patients.
Increasing surgeon age is almost linearly associated with decreases in patient death, readmission & post-operative complications.
Interestingly that the difference disappeared when only high-volume physicians were considered, suggesting a very believable link between clinical volume and quality maintenance.
Patients treated by older physicians experience higher 30-day mortality than with younger physicians.
What did they do?
Fascinating big-data study covering 12 years of the 20-most-common surgical procedures in Ontario, Canada. Wallis, Jerath & co. investigated how patient-surgeon sex discordance correlated to a composite for adverse postoperative outcomes. (A deeper investigation of the related Wallis 2017 study).
And they found?
While ~15% of all patients experienced an adverse post-operative outcome, female patients treated by a male surgeon experienced significantly higher odds of a composite of adverse events (OR 1.15 [1.10-1.20]), 30-day complications (OR 1.16 [1.11-1.22]), readmissions (OR 1.11 [1.04-1.19]), and death (OR 1.32 [1.14-1.54]) compared to when treated by female surgeons.
Yet male patients treated by female surgeons experienced either lower odds (death 0.87 [0.78-0.97]) or statistically-similar odds of complications (composite end-point, readmission or post-op complications).
Women once again receive the metaphorical short-end of the medical-stick. Whether societal or elsewhere in the health industry value-chain, long established gender inequity reveals itself in worse surgical outcomes for female patients.
Hang on a sec…
But this cannot just be written off as a consequence of existing social gender inequity, but rather a disquieting causal loop between this as a cause and the result then perpetuating further inequity.
If some part of a surgeon’s ’professional success’ is wrapped-up in the ability to achieve positive outcomes for patients while minimising the adverse, then male surgeons are failing their female patients when compared to either female surgeons, or to the care they provide their male patients.
And yet the same discordance cost is not true for female surgeons.
If you are a male surgeon at all interested in successful patient outcomes (surely that’s every surgeon?), then this should make you very, very uncomfortable. At the very least it should make male surgeons stop and consider whether their female colleagues conduct any aspects of their practice differently – particularly when treating female patients.
Treatment from female surgeons is associated with a lower 30 day mortality than the same from male surgeons.
Care from male surgeons and/or anaesthesiologists is associated with longer lengths of stay after cardiac surgery.