Among all of us who operate, there is an innate desire to improve surgical outcomes. This goal drives nearly all the research we do, whether innovating new surgical techniques, diving deeper into the pathways of disease to allow novel treatment paradigms, or working to better understand the factors that contribute to surgical outcomes. For years, we have known that patient factors including age, sex, comorbidity, and others have important associations with surgical outcomes. More recently, we (among other groups) have examined the effect of surgeon characteristics on surgical outcomes, finding that patients treated by female surgeons have better postoperative outcomes.^1,2 The underlying reasons for this are likely multifactorial and likely include communication style, practice patterns, physician-patient relationships, and potentially patient selection.^1-3

In our first foray into this question (published in 2018), we performed a large observational study that captured more than 1 million adults undergoing common surgeries in Ontario, Canada, which demonstrated better postoperative outcomes (captured as a composite of 30-day mortality, readmission, and complications) in patients undergoing surgery by female surgeons as compared to those treated by male surgeons (adjusted odds ratio [AOR], 0.96; 95% CI, 0.92-0.99), including a detectable association with mortality (AOR, 0.88; 95% CI, 0.79-0.99).³ However, improved health outcomes in the short-term cannot necessarily be extrapolated to longer-term persistent effects. As such, study of longer-term data is necessary to evaluate patient outcomes beyond 30 days after an operation. If the improved health results of patients with female surgeons persists in the long term, it becomes important to evaluate the broader implications of diversifying surgical practice across all surgical specialties.

Using an updated version of the same cohort from which the 30-day postoperative outcome data were collected, we identified 1,165,711 unique patients, undergoing 25 common surgeries in Ontario between January 1, 2007, to December 31, 2019. Most patients (76.7%) were treated by male surgeons while 23.3% were treated by female surgeons. Our primary outcome was any adverse postoperative outcome, defined as a composite of death, readmission, or complication within 1 year after surgery.⁴ We also assessed this composite end point at 90 days and investigated individual outcomes including mortality, readmission, and surgical complications for which we applied a previously applied definition of major morbidity including reoperation.⁴

The results of the study revealed compelling differences in long-term postoperative outcomes based on the surgeon’s sex. Patients treated by female surgeons exhibited lower rates of adverse outcomes at 90 days and 1 year following surgery. Specifically, at 90 days, the adverse postoperative outcome rate was 12.5% for female surgeons’ patients compared to 13.9% for male surgeons’ patients after adjusting for patient-, surgeon-, anesthesiologist-, and hospital-level covariates (Table). Similarly, at 1 year, the rates were 20.7% for female surgeons’ patients and 25.0% for male surgeons’ patients. These disparities were observed across each of the secondary end points, including mortality, readmission, and complications at both 90 days (males: 0.8%; 95% CI, 0.4%-1.6% vs females: 0.5%; 95% CI, 0.3%-1.1%; AOR, 1.25; 95% CI, 1.12-1.39) and 1 year (males: 2.4%; 95% CI, 1.2%-4.8% vs females: 1.6%; 95% CI, 0.8%-3.1%; AOR, 1.24; 95% CI, 1.13-1.36).⁵

Table. Multivariable Adjusted Event Rates and Outcomes^a

While there are inevitable questions regarding patient demographics and surgical indications, this study employed robust case-mix adjustment and matched directly on the procedure performed (as indicated by billing codes).

While this study highlights the pivotal role of female surgeons in improving patient outcomes, it also calls for a deeper exploration of the underlying factors contributing to these differences. Researchers stressed the importance of understanding the unique aspects of surgical practice, including interpersonal interactions and decision-making processes, which might explain the observed disparities.

The findings underscore the critical need for diversification in the surgical workforce. By supporting and promoting women in surgery, health care organizations can enhance patient care outcomes. Furthermore, the study’s outcomes have broader implications for health care delivery, emphasizing the significance of embracing diverse perspectives and practices to improve overall patient experiences and outcomes.

As the medical community continues to grapple with these findings, further research and qualitative investigations are essential to unravel the complexities of surgeon-patient interactions. By fostering an inclusive environment that values diverse skills and approaches, the health care sector can move closer to achieving optimal patient outcomes and delivering equitable care for all.