Study suggests patients less likely to die if surgeon is female; more patient-centered care and superior communication the likely reason.

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The News:

Women have long struggled for equal recognition in the male-dominated medical profession, but a new study suggests that female surgeons may have the upper–and possibly steadier–hand.

Patients who are operated upon by women are less likely to die in the month following surgery, according to new findings. Canadian researchers say they are puzzled as to why women appear to perform better, but have suggested they may be better at communicating or more willing to follow guidelines.

To find out if there was a difference in death rates for male and female surgeons, the team from the University of Toronto looked back over 104,630 patients who were treated by 3,314 surgeons between 2007 and 2015. Patients were matched for age, sex, presence of other conditions and income, while surgeons were matched for age, experience, volume of operations and hospital.

The risk of dying within 30 days following an operation was 12% less if a woman operated. There was no significant difference in readmissions to hospital or complications.

Raj Satkunasivam, MD, of Houston Methodist Hospital, and colleagues said, “Women and men practice medicine differently, although little research exists on the differences in learning styles, acquisition of skills, or outcomes for female and male surgeons. “We don’t know the mechanism that underlies better outcomes for patients treated by female surgeons, although it might be related to delivery of care that is more congruent with guidelines, more patient centered, and involves superior communication.”

Although around 58% of medical students are now women, just 11% of surgeons in Britain are female, for example, according to The Telegraph. Previous studies have shown that female medical students are better at basic surgical skills and gain higher scores on theoretical surgical knowledge tests. But the new study is the first time the difference has been observed in patient outcomes.

The research was published in the British Medical Journal.

Steve’s Take:

So, let me get this straight: female surgeons are less likely to kill you?

This seems clear from the BMJ study, but there are reasons to be skeptical

Surgical death rates are usually low in the first place so the numbers might not be as significant as the headline suggests. And there may be risk stratification if female surgeons don’t have the same mix of patients as their male counterparts. Other potential objections to the reliability have been raised (see the article’s comments for examples).

But accounting for different patient, physician, and hospital characteristics did not sway the main findings, Satkunasivam’s group found, but a subanalysis on emergent operations did, according to MedPage Today.

“Our retrospective analyses of emergent operations, where patients are less likely able to select or be biased towards a surgeon of a particular sex, partly support the possibility of confounding. We found that the benefit in composite outcome for patients treated by female surgeons was restricted to elective procedures,” they noted.

“Regardless, outcomes for patients treated by female surgeons were never worse than for those treated by male surgeons,” they stated.

That was an important point that Clare Marx, MBBS, and Derek Alderson, MD, respectively the immediate past and current presidents of the Royal College of Surgeons in London, highlighted in an accompanying editorial.

“Surgery is a specialty that continues to struggle with unconscious bias among patients and health professionals, and gender inequality persists. In this large Canadian study only 23.4% of surgeons were female, and only 12.4% of patients were treated by women,” they wrote. “This study helps to combat these lingering biases by confirming the safety, skill, and expertise of women surgeons relative to their male colleagues.”

The headline appears to me to accurately characterize the research paper. It looks about as well executed as such a study could be, with the data available. Be wary, however, of popular science news articles which ignore the authors’ caveats.

The phrasing in the article is a bit equivocal as to the 12%. To be clear, it’s the difference in relative risk, not difference in absolute risk.

Bottom Line:

Steve's Take: Latest study showing #women make better #surgeons looks convincing to me Click To Tweet

I see nothing obviously wrong with the research paper. The authors themselves are clear about the limits of their analysis and the possibility that some findings could be due to unknown “confounding” (i.e., baffling) variables.

“We were able to comprehensively capture patients undergoing the selected surgical procedures because of single payer healthcare in Ontario. Unlike Tsugawa et al, who were limited to Medicare beneficiaries aged 65 years and older, we identified all adult patients who had the procedures of interest. This is particularly important because patients treated by female physicians were younger than those treated by male surgeons. Moreover, the nature of the healthcare system enabled us to capture readmissions and complications occurring anywhere in the province, including at hospitals other than where the index surgery was performed.”

Another study researching female internists attribute similar results to the female doctors’ ability to communicate and engage with their patients and their adeptness at collaborating with colleagues. The same factors possibly linked to female internists could also play a role among surgeons. Also, generally only the best women in the profession become surgeons in the typically male-dominated field.

Still, sceptics insist the difference in death rates is far smaller than the research paper makes it sound. After reading the report of the study and its findings, however, I’m not buying into such skepticism. Sorry, gents.

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