Hospital surgical teams that include more female doctors improve patient outcomes, lower the risk of serious complications and could in turn reduce healthcare costs, according to the world’s largest study of its kind.
Studies show diversity is important in business, finance, tech, education and the law not only for equity but for output. However, evidence supporting the value of sex diversity in healthcare teams has been limited.
Now researchers who examined more than 700,000 operations spanning a decade report that hospitals with more women in their surgical teams provide better outcomes for patients. The findings were published in the British Journal of Surgery.
“Care in hospitals with greater anaesthesia-surgery team sex diversity was associated with better postoperative outcomes,” the researchers concluded. “The main takeaway for clinical practice and health policy is that increasing operating room teams’ sex diversity is not a question of representation or social justice, but an important part of optimising performance.
“Healthcare institutions should intentionally foster sex diversity in operating room teams to potentially reduce major morbidity, which, in turn, can enhance patient satisfaction and reduce costs.”
In the study, led by the University of Toronto, researchers analysed 709,899 elective operations that took place in 88 hospitals in Ontario, Canada, between 2009 and 2019.
Of those surgeries, 90-day major morbidity – serious complications within three months of the operation – occurred in 14.4% of cases. The median proportion of female anaesthesiologists and surgeons a hospital a year was 28%.
Overall, female surgeons performed 47,874 (6.7%) of the operations. Female anaesthesiologists treated patients in 192,144 (27%) of operations.
Hospitals with teams comprising more than 35% female surgeons and anaesthesiologists had better postoperative outcomes, the study found. Operations in such hospitals were associated with a 3% reduction in the odds of 90-day postoperative major morbidity in patients.
The researchers noted that the 35% threshold they observed echoed findings from research in other industries in various countries, including the US, Italy, Australia and Japan, that also showed better outcomes once teams had 35% female members.
“Care by a female surgeon increased the association of higher team sex diversity with outcomes, whereas this was not observed for care by a male surgeon,” the researchers added.
“This indicates that having higher team sex diversity and care by a female surgeon had a greater association with outcomes than the sum of each. The same was observed for care by female anaesthetists.”
Dr Julie Hallet, the lead author of the study at the University of Toronto, said: “These results are the start of an important shift in understanding the way in which diversity contributes to quality in perioperative care.”
“Ensuring a critical mass of female anaesthesiologists and surgeons in operative teams isn’t just about equity; it seems necessary to optimise performance.”
Previous studies have suggested that patients who are operated on by women are less likely to experience complications or need follow-up care than when treated by men.
However, Hallet said her research team wanted to challenge “the binary discourse of comparing female and male clinicians” and instead “highlight the importance of diversity as a team asset or bonus in enhancing quality care”.
Improving sex diversity in surgical teams will require “intentional effort” to ensure systematic recruitment and retainment policies for female doctors, she added.
