Women are more likely to die in surgery, experience severe complications, and be re-hospitalized if the surgeon operating on them is a man, according to a new study of Ontario surgical patients. Men’s outcomes, meanwhile, stay similar, regardless of their surgeon’s gender.
The study, performed in part by researchers at the University of Toronto, was published in JAMA Surgery.
Researchers looked at 1.3 million adult patients who had one of 21 common surgeries in Ontario from 2007 to 2019. The surgeries included both emergency and elective procedures, among them appendix removal, hip and knee replacements, weight loss procedures and brain surgery. The procedures were performed by a total of 2,937 doctors.
They found that women were 32 per cent more likely to die if their surgeon was male than female. Female patients with male surgeons were also 20 per cent more likely to have a longer hospital stay, 16 per cent more likely to have complications from the surgery, and 11 per cent more likely to be re-admitted to the hospital.
The results are troubling, one of the study’s co-authors, clinical epidemiologist and U of T professor Dr. Angela Jerath, told The Guardian.
“This result has real-world medical consequences for female patients,” she said. “We have demonstrated in our paper that we are failing some female patients and that some are unnecessarily falling through the cracks with adverse, and sometimes fatal, consequences.”
It’s not clear why women have such different outcomes based on their doctor’s gender. “Both sexes undergo the same technical medical training,” Jerath pointed out.
One potential explanation, she said, is implicit bias: surgeons may “act on subconscious, deeply ingrained biases, stereotypes and attitudes.”
Women less likely to be believed
Previous studies have also found that women are less likely to be believed when they report physical or mental health problems: a study published in Academic Emergency Medicine, for instance, showed that women who went to the hospital with severe stomach pain were made to wait almost 33 per cent longer than men who had the exact same symptoms. Additionally, women are seven times more likely than men to be misdiagnosed and dismissed while having a heart attack.
One of the underlying reasons for these discrepancies may be “differences between male and female physician work style, decision-making and judgment,” Jerath proposed.
Doctors’ decision-making was the subject of another recent University of Toronto study. An analysis of nearly 40 million surgical referrals in Ontario found that male doctors are more likely to refer patients to male surgeons than to “similarly qualified and experienced” female surgeons. Male surgeons also make 24 per cent more money than women in the field.
“During my 20 years in practice, I always had the sense it was easier for my male surgical colleagues to get referrals than it was for me, and the patients they were referred were more likely to need surgery,” Nancy Baxter, senior author on the referrals study, told U of T’s news site.
“Our work demonstrates that my observations were not unique but reflect gender bias that affects the lives and livelihoods of all female surgeons in the province.”
Maija Kappler is a reporter and editor at Healthing. She can be reached at firstname.lastname@example.org