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Surgeon Self-Reported Gender Does Not Prognosticate Outcomes in Current U.S. Practice
Salvatore T. Scali1, *Jesse A. Columbo2, Mary Hawn3, Erica L. Mitchell4, Sandra L. Wong5, Thomas S. Huber1, Gilbert R. Upchurch, Jr.1, David H. Stone2
1Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL; 2Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH; 3Department of Surgery, Stanford University, Palo Alto, CA; 4Division of Vascular Surgery and Endovascular Therapy, University of Tennessee-Memphis, Memphis, TN; 5Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH

Objectives: Previous work has implicated a surgeon's sex as potentially prognostic for clinical outcomes. The underlying etiology for these findings remains undefined and accordingly, debate persists. The purpose of this study was to better determine whether the operating surgeon's self-reported gender impacted clinical outcomes in contemporary U.S. surgical practice.

Methods: We used the Vizient clinical database to study patients who underwent one of 39 different surgical procedures across specialties in elective and emergent settings. We chose and categorized procedures according to the CDC's National Healthcare Safety Network. We combined patient-level data with publicly available surgeon-reported gender and specialty information. Our primary exposure was the self-reported gender of the operating surgeon (defined in the dataset as male or female). Our primary outcome was a composite of major in-hospital complications, readmission within 30-days, or death. We used propensity score matching, including patient, surgeon, and hospital level variables, for risk adjustment.

Results: We identified 5,020,573 patients from 2016-2021 who underwent surgery by 12,412 female surgeons (31.4% of surgeons, performing 20.8% of procedures) and 27,091 male surgeons (68.6% of surgeons, performing 79.2% of procedures). Female surgeons were younger (female: mean age 45.6±9.1 years versus male: 52.6±11.1; p<0.001) and had comparatively lower operative volumes. The primary outcome occurred in 13.6% of patients (female surgeons: 10.8% versus male surgeons: 14.3%; p<0.0001). Approximately 70% of cases done by female surgeons were propensity matched to yield 683,433 pairs. Overall, the primary outcome occurred in 13.0% of patients and did not differ by surgeon sex (13.0% female versus 13.0% male; p=0.697). Individual outcomes of mortality (1.0% F, 1.1% M, p=.13), readmission (10.3% F, 10.3% M, p=.54), and major complication (2.6% F, 2.6% M, p=.38) were not different by surgeon sex. When stratified by procedure, the primary composite outcome was less common among female surgeons for breast, hernia, kidney transplant, neck, and rectal surgery, and was less common among male surgeons for craniotomy, cesarean section, spinal fusion, open fracture reduction, hip surgery, and ventricular shunt placement, though most of these associations were small (Figure).

Conclusions: In the largest analysis to date, surgeon self-reported gender does not appear to have a clinically meaningful impact on operative outcomes in current U.S. practice. While there were nuanced variations across different surgical procedures, the effect of surgeon gender is small and does not implicate an innate sex-based difference in surgical care delivery. Patients should more appropriately consider individual surgeon and center outcomes-based performance when in need of surgical referral.

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