The Sex of Your Surgeon Is, in Fact, a Matter of Life or Death

Angela Jerath, an associate professor of anesthesiology at the University of Toronto, was interviewed by journalist, Danielle Groen. A section of the interview is below. Read the entire interview.

Early this year, a Canadian study published in JAMA Surgery confirmed what many patients, especially female patients, have long suspected: The sex of your surgeon absolutely matters when it comes to your outcome in the operating room. Female physicians got better results. But it turns out that the sex of the patient matters in the OR, as well—and can even mean the difference between life and death.

Angela Jerath, an associate professor of anesthesiology at the University of Toronto, and her colleague Christopher Wallis, an assistant professor of surgery in the department of urology, canvassed the records of more than 1.3 million men and women, operated on by nearly 3,000 surgeons in Ontario over 12 years. They controlled for as many factors as possible: the age, income, and health status of the patients; the age and experience level of the surgeons; whether the surgery was performed in a small community hospital or a major medical centre. Overall, Jerath and Wallis discovered, more than 17 percent of patients suffered adverse effects within 30 days of the procedure—8.7 percent of them had complications, 6.7 percent were readmitted to hospital, 1.7 percent died. Not the best.

But when they broke down those results by sex, something more troubling emerged. “We found that female patients treated by male surgeons had 15 percent greater odds of adverse outcomes than female patients treated by female surgeons,” Jerath says. Worse still: Women operated on by a male surgeon were 32 percent more likely to die.

Here, Jerath unpacks those astonishing findings and explains how on earth we can fill the gap in care for female patients.

Why did you want to explore this area in the first place?

Chris Wallis had done some earlier work that looked at differences in outcomes between male and female surgeons, using a similar dataset from Ontario health care. That paper signalled that female surgeons across different specialities are having better outcomes than their male counterparts. And we weren’t really sure why. To be honest, we’re still trying to work out why. But one of the areas of interest was whether the interaction between the sex of the physician and the sex of the patient matters.

How did you go about measuring whether it matters?

We have the luxury of lots of health care databases in Ontario, and they’re completely anonymized. We looked at the pairings between the sex of the patient and the physician—so you’ve got four combinations—and we looked at its impact on death, readmission to hospital, or complications after surgery within 30 days. This was on around 21 surgical procedural groups, from things that are really complex, like cardiac bypass surgeries, to common bread-and-butter stuff, like having your hip or knee replaced. We were able to adjust for a lot of things that affect outcomes, like the age of the patient or the experience of the surgeon. We jam-packed those things into the model and came out with the numbers that you see.

Let’s talk about those numbers.

They’re pretty scary.

What did you think when you first saw them?

I was personally taken aback. We had a lot of internal discussions and went through the data again. Chris had done that earlier work, so we knew there was a signal here, but we just didn’t know how big the signal was going to be. It’s important to understand what those numbers might mean. They’re what we call relative numbers. Women having surgery with a male surgeon, relative to a female surgeon, had a 32 percent increased risk for death. That means if your risk for death coming in for surgery is, let’s say, one percent, then it’s 32 percent of that one percent—so the combined outcome is about 1.3 percent. That’s how to mentally compute what you’re seeing.

But should there be a difference at all?

No. And that needs a deep dive. We saw this difference across a lot of surgeries, and there were 1.3 million procedures in our database. Given that volume, we don’t sense that this is some technical thing in the operating room. The operating room is just one part of your surgical experience, which starts as soon as you step into the hospital and meet the team.

What do you think is going on here?

There may be differences around communication, understanding what a patient wants; perhaps there’s a difference in decision-making. Very few people die in the operating room. Most things happen after surgery, and picking up on those complications early can be life-saving. Perhaps men and women physicians are communicating with their teams differently. Perhaps they’re listening to patients differently. There are a lot of subtleties, which I will say don’t get taught at medical school, that might feed into some of those adverse outcomes. There are likely to be differences in style that we can all learn from.