People who are operated on by female surgeons are less likely to experience complications and need follow-up care than when males wield the scalpel, according to two major studies that suggest male surgeons have important lessons to learn.
Doctors in Canada and Sweden reviewed more than 1m patient records from two separate medical registers and found that patients seen by female surgeons had significantly better outcomes with fewer problems in the months after the operation.
The researchers are investigating potential reasons for the differences, but the records suggest that female surgeons tend to operate more slowly and may achieve better results by taking their time in the operating theatre.
Dr Christopher Wallis, who led one of the studies at Mount Sinai hospital in Toronto, said the findings should prompt male surgeons to reflect on their approach to surgery and learn from female colleagues for the benefit of their patients. “As a male surgeon, I think these data should cause me and my colleagues to pause and consider why this may be,” he said.
Wallis’s team looked at medical complications, readmission to hospital, and death rates after surgery in nearly 1.2 million Ontario patients between 2007 and 2019. The records included 25 different surgical procedures on the heart, brain, bones, organs and blood vessels.
The analysis, reported in Jama Surgery, showed that 90 days after an operation, 13.9% of patients treated by a male surgeon had “adverse post-operative events”, a catch-all term that includes death and medical complications ranging from problems that require further surgery to major infections, heart attacks and strokes. The equivalent figure for patients seen by female surgeons was 12.5%.
Patients seen by female surgeons fared better one year after surgery too, with 20.7% having an adverse postoperative event, compared with 25% of those seen by male surgeons. When the doctors looked purely at deaths post-surgery, the difference was even starker: patients treated by male surgeons were 25% more likely to die one year after surgery than those treated by female surgeons.
A second study of 150,000 patients in Sweden, also published in Jama Surgery, paints a similar picture. Dr My Blohm and colleagues at the Karolinska Institute in Stockholm reviewed patient outcomes after surgery to remove the gallbladder. They found that patients treated by female surgeons suffered fewer complications and had shorter hospital stays than those treated by men. The female surgeons operated more slowly than their male colleagues and were less likely to switch from keyhole to open surgery during an operation.
Blohm said that, as with all observational studies, the results should be treated with caution, but the findings suggest that surgical technique and risk-taking might explain some of the differences observed. “In some countries there is a general belief that male surgeons are superior to female surgeons,” she said. “Interestingly, most previously published studies indicate that female surgeons are at least as good as male surgeons, or as in this case even slightly better.”
Wallis said there were “numerous lessons” to learn. “Men and women differ in how they practise medicine. Embracing or adopting some practices that are more common among female physicians is likely to improve outcomes for my patients,” he said. “Since undertaking this work, I have certainly done this personally and would encourage my colleagues to do the same: use this as a moment for introspection.”
Beyond attracting more women to surgery, Wallis said there was a need to “evolve” surgery to ensure it better retained women and promoted them to positions of influence. “There is a wealth of data that we have a so-called leaky pipeline with diminishing numbers of women in senior positions,” he said.
In an accompanying editorial, Prof Martin Almquist at Skåne University hospital in Sweden writes: “The fact that female surgeons had operations with fewer complications but longer operation times suggests that the Navy Seal mantra ‘slow is smooth, and smooth is fast’ also applies to surgery.”
Tim Mitchell, President of the Royal College of Surgeons of England, said the findings added to a growing literature pointing to differences in patient outcomes for male and female surgeons.
“This association is interesting and important,” he said. “However, association is not causation, and one possible explanation may have to do with case complexity. The authors tried to take the case mix into account by adjusting for confounders, but residual confounding factors cannot be ruled out. I agree that the ideal of the surgeon as the ‘lonesome cowboy’ belongs to an era long gone.”
