Surgeon Gender and Post-Operative In-Hospital Mortality Post-Operative Mortality

Main Article Content

Tara M Barry Haroon M Janjua Evelena Cousin-Peterson Mary Ottinger Paul C Kuo

Abstract

Background: Prior studies report improved mortality rates for patients of female internists, few studies have evaluated the effect of surgeon gender on post-operative mortality.


Methods: A retrospective analysis using the Agency for Health Care Administration Florida database from 2010-2015 examined patients undergoing one of 25 selected surgical procedures. Surgeon gender (self-reported), number of Medicare beneficiaries and years of experience were imported from CMS Physician Compare/Provider Utilization & Payment Data set using NPI. 25 procedures of varying complexity from all subspecialties were selected. For each procedure, inverse probability of treatment weighting (IPTW) was used to match cases performed by male vs female surgeons to achieve maximum balance between the groups.


Results: There were 73,994 admissions for patients undergoing surgical procedures performed by 2,828 surgeons(361 females, 2467 males). Fewer patients who had emergent procedures performed by female surgeons died in the hospital(291/13957,2.08% vs 348/14017,2.48% p=0.026). Those who underwent the following procedures had significantly lower rates of in-hospital mortality if the surgeon was female: CABG(2/387,0.52% vs 8/387,2.07%), mastectomy(2/4797,0.04% vs 10/4797,0.21%), open cholecystectomy(7/955,0.73% vs 17/955, 1.78%) all p≤0.05.


Conclusion: Patients who underwent CABG, mastectomy and open cholecystectomy had lower rates of in-hospital mortality if the surgeon was female while male surgeons did not have a significant mortality advantage for any procedure. Further studies examining national data may provide additional insight regarding the effect of surgeon gender on patient outcomes.

Article Details

How to Cite
BARRY, Tara M et al. Surgeon Gender and Post-Operative In-Hospital Mortality. Medical Research Archives, [S.l.], v. 9, n. 11, nov. 2021. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/2591>. Date accessed: 17 apr. 2024. doi: https://doi.org/10.18103/mra.v9i11.2591.
Section
Research Articles

References

1. Colleges AoAM. Medical School Applications and Matriculants by School, State of Legal Residence, and Sex 2019-2020. 2020.
2. Colleges AoAM. AAMC Faculty Salary Survey MD or Equivalent Faculty by Gender. 2019.
3. Bernardi K, Shah P, Lyons NB, Olavarria OA, Alawadi ZM, Leal IM, et al. Perceptions on gender disparity in surgery and surgical leadership: A multicenter mixed methods study. Surgery. 2020;167(4):743-50. Epub 2020/01/26. doi: 10.1016/j.surg.2019.12.004. PubMed PMID: 31980138.
4. Gomez LE, Bernet P. Diversity improves performance and outcomes. J Natl Med Assoc. 2019;111(4):383-92. Epub 2019/02/16. doi: 10.1016/j.jnma.2019.01.006. PubMed PMID: 30765101.
5. West MA, Hwang S, Maier RV, Ahuja N, Angelos P, Bass BL, et al. Ensuring Equity, Diversity, and Inclusion in Academic Surgery: An American Surgical Association White Paper. Ann Surg. 2018;268(3):403-7. Epub 2018/07/14. doi: 10.1097/sla.0000000000002937. PubMed PMID: 30004923.
6. Carapinha R, Ortiz-Walters R, McCracken CM, Hill EV, Reede JY. Variability in Women Faculty's Preferences Regarding Mentor Similarity: A Multi-Institution Study in Academic Medicine. Academic medicine : journal of the Association of American Medical Colleges. 2016;91(8):1108-18. Epub 2016/06/23. doi: 10.1097/acm.0000000000001284. PubMed PMID: 27332871; PubMed Central PMCID: PMCPMC4965308.
7. Marks IH, Diaz A, Keem M, Ladi-Seyedian SS, Philipo GS, Munir H, et al. Barriers to Women Entering Surgical Careers: A Global Study into Medical Student Perceptions. World J Surg. 2020;44(1):37-44. Epub 2019/10/17. doi: 10.1007/s00268-019-05199-1. PubMed PMID: 31616970.
8. Reed CE, Vaporciyan AA, Erikson C, Dill MJ, Carpenter AJ, Guleserian KJ, et al. Factors dominating choice of surgical specialty. Journal of the American College of Surgeons. 2010;210(3):319-24. Epub 2010/03/03. doi: 10.1016/j.jamcollsurg.2009.11.016. PubMed PMID: 20193895.
9. Sharoky CE, Sellers MM, Keele LJ, Wirtalla CJ, Karakousis GC, Morris JB, et al. Does Surgeon Sex Matter?: Practice Patterns and Outcomes of Female and Male Surgeons. Ann Surg. 2018;267(6):1069-76. Epub 2017/07/26. doi: 10.1097/SLA.0000000000002460. PubMed PMID: 28742695.
10. Wallis CJ, Ravi B, Coburn N, Nam RK, Detsky AS, Satkunasivam R. Comparison of postoperative outcomes among patients treated by male and female surgeons: a population based matched cohort study. BMJ. 2017;359:j4366. doi: 10.1136/bmj.j4366.
11. Tsugawa Y, Jena AB, Figueroa JF, Orav EJ, Blumenthal DM, Jha AK. Comparison of Hospital Mortality and Readmission Rates for Medicare Patients Treated by Male vs Female Physicians. JAMA Internal Medicine. 2017;177(2):206-13. doi: 10.1001/jamainternmed.2016.7875.
12. [dataset] Physician Compare Data. Centers for Medicare & Medicaid Services; 2016.
13. [dataset] Hospital Inpatient Data File Agency for Health Care Administration State of Florida; 2010-2015.
14. Donati A, Ruzzi M, Adrario E, Pelaia P, Coluzzi F, Gabbanelli V, et al. A new and feasible model for predicting operative risk. BJA: British Journal of Anaesthesia. 2004;93(3):393-9. doi: 10.1093/bja/aeh210 %J BJA: British Journal of Anaesthesia.
15. Austin PC, Stuart EA. Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies. Statistics in medicine. 2015;34(28):3661-79. Epub 2015/08/05. doi: 10.1002/sim.6607. PubMed PMID: 26238958; PubMed Central PMCID: PMCPMC4626409.
16. Rosenbaum PR. Model-Based Direct Adjustment. Journal of the American Statistical Association. 1987;82(398):387-94. doi: 10.2307/2289440.
17. Ho D, Imai K, King G, Stuart EA. MatchIt: Nonparametric Preprocessing for Parametric Causal Inference. 2011. 2011;42(8):28 %J Journal of Statistical Software. Epub 2011-06-14. doi: 10.18637/jss.v042.i08.
18. Stagg V. CHARLSON: Stata module to calculate Charlson index of comorbidity. Statistical Software Components S456719, Boston College Department of Economics; revised 13 Sep 2017.
19. Doyle CM, Lix LM, Hemmelgarn BR, Paterson JM, Renoux C. Data variability across Canadian administrative health databases: Differences in content, coding, and completeness. 2020;29(S1):68-77. doi: 10.1002/pds.4889.
20. Nelson JA. Gender and Risk-Taking: Economics, Evidence, and Why the Answer Matters: Taylor & Francis; 2017.
21. Colleges. AoAM. Table 13: US medical school faculty by sex, rank, and department. 2018.
22. Colleges AAoM. Distribution of Residents by Specialty, 2005 Compared to 2015. 2016.
23. Dorrance HR, Docherty GM, O'Dwyer PJ. Effect of surgeon specialty interest on patient outcome after potentially curative colorectal cancer surgery. Diseases of the colon and rectum. 2000;43(4):492-8. Epub 2000/05/02. doi: 10.1007/bf02237192. PubMed PMID: 10789744.
24. Henrickson Parker S, Flin R, McKinley A, Yule S. The Surgeons' Leadership Inventory (SLI): a taxonomy and rating system for surgeons' intraoperative leadership skills. Am J Surg. 2013;205(6):745-51. Epub 2012/08/08. doi: 10.1016/j.amjsurg.2012.02.020. PubMed PMID: 22867725.
25. Minehart RD, Foldy EG, Long JA, Weller JM. Challenging gender stereotypes and advancing inclusive leadership in the operating theatre. Br J Anaesth. 2020;124(3):e148-e54. Epub 2020/02/01. doi: 10.1016/j.bja.2019.12.015. PubMed PMID: 32000976.
26. Arora S, Ashrafian H, Davis R, Athanasiou T, Darzi A, Sevdalis N. Emotional intelligence in medicine: a systematic review through the context of the ACGME competencies. Med Educ. 2010;44(8):749-64. Epub 2010/07/17. doi: 10.1111/j.1365-2923.2010.03709.x. PubMed PMID: 20633215.
27. Myers JA, Rassen JA, Gagne JJ, Huybrechts KF, Schneeweiss S, Rothman KJ, et al. Effects of adjusting for instrumental variables on bias and precision of effect estimates. Am J Epidemiol. 2011;174(11):1213-22. Epub 2011/10/26. doi: 10.1093/aje/kwr364. PubMed PMID: 22025356; PubMed Central PMCID: PMCPMC3254160.
28. McKay A, You I, Bigam D, Lafreniere R, Sutherland F, Ghali W, et al. Impact of surgeon training on outcomes after resective hepatic surgery. Ann Surg Oncol. 2008;15(5):1348-55. Epub 2008/03/01. doi: 10.1245/s10434-008-9838-9. PubMed PMID: 18306973.
29. Stephens EH, Heisler CA, Temkin SM, Miller P. The Current Status of Women in Surgery: How to Affect the Future. JAMA Surgery. 2020. doi: 10.1001/jamasurg.2020.0312 %J JAMA Surgery.