Importance. Evidence suggests that physician gender and patient-physician gender concordance have the potential to improve patient outcomes, especially for female patients. However, whether long-term outcomes differ by surgeon gender and patient-surgeon gender concordance has not been studied in the US. Objective. To compare long-term postoperative outcomes by surgeon gender and patient-surgeon gender concordance. Design, setting, and participants. A population-based cross-sectional studywas conducted based on 100% Medicare fee-for-service claims data from 2016 through 2019. Data analysis was performed between October 17, 2023, and January 28, 2025. The study took place at acute care hospitals in the US. Participants included Medicare fee-for-service beneficiaries aged 65 to 99 years who underwent 1 of 14 elective or emergent surgeries. Exposures. Surgeon gender and patient-surgeon gender concordance. Main outcomes and measures. Ninety-day and 1-year postoperative mortality, readmission, and complication rates were compared by surgeon gender and patient-surgeon gender concordance. The study team adjusted for patient and surgeon characteristics and hospital fixed effects, effectively comparing patients within the same hospital. Results. Among 2 288 279 patients who underwent surgery, 129 528 were operated on by female surgeons (5.7%) and 2 158 751 were by male surgeons (94.3%). Patients treated by female surgeons experienced a lower long-term mortality rate compared with those treated by male surgeons (adjusted 90-day mortality rates, 2.6% for female surgeons vs 3.0% for male surgeons; adjusted risk difference [aRD], −0.3 percentage points [pp]; 95% CI, −0.5 pp to −0.2 pp; P<0.001), similarly for both female and male patients. For female patients, the patient-surgeon gender concordance was associated with lower long-term readmission (adjusted 90-day readmission rates, 7.3%vs 7.7%; aRD, −0.4 pp; 95% CI, −0.7 pp to −0.2 pp; P=0.001) and complication rates (adjusted 90-day complication rates, 12.2%vs 12.8%; aRD, −0.5 pp; 95% CI, −0.9 pp to −0.2 pp; P=0.005). For male patients, long-term readmission and complication rates did not differ between patients treated by female vs male surgeons. Similar patterns were found between 90-day and 1-year patient outcomes. Conclusions and relevance. In this study, both female and male patients treated by female surgeons experienced lower long-term postoperative mortality rates compared with those treated by male surgeons. Patient-surgeon gender concordance was associated with lower long-term readmission and complication rates for female patients, but not for male patients. These patterns were observed only for elective procedures and may not be generalizable to other populations, such as younger patients.
Commentaire du Dr Marius Laurent (PAQS)
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Divers articles ont souligné qu’à court terme, les résultats d’interventions menées par des chirurgiennes sont meilleurs que ceux obtenus par des hommes. On a avancé l’explication d’un meilleur respect des recommandations. À court terme, le fait pour un patient d’être opéré par un chirurgien du même sexe améliore le pronostic, surtout celui des femmes. On a avancé ici une meilleure qualité de la communication médecin-patient dans le sens favorable, et une persistance de clichés menant à une sous-estimation des plaintes de patientes par les hommes. L’article explore si on peut trouver les mêmes résultats si on regarde les résultats à plus long terme. L’étude porte sur les résultats de chirurgie sur des patients MediCare de 65 à 99 ans opérés entre 2016 et 2019 : 2 288 000 patients, dont 5,7% opérés par une chirurgienne (j’imagine que cette proportion est appelée à croître). Les mortalités à 90 jours et à un an sont inférieures pour les chirurgiennes, quel que soit le sexe de la personne opérée. En ce qui concerne les complications et les réadmissions à 90 jours et à un an, la tendance est la même. On ne s’étonnera donc pas qu’une patiente opérée par une chirurgienne ait un meilleur pronostic que si elle était opérée par un homme. Cependant, les patients hommes ont des taux de réadmission et de complications semblables qu’ils soient opérés par un homme ou une femme. Les raisons de ces différences méritent d’être investiguées : on peut suspecter des disparités entre hommes et femmes dans la distribution des interventions, des plages horaires et des patients si on se réfère à celles qui existent dans les honoraires réellement perçus et dans l’accès au haut des échelles hiérarchiques.
Ikesu R, Gotanda H, Russell TA, et al. Long-term postoperative outcomes by surgeon gender and patient-surgeon gender concordance in the US. JAMA Surg. 2025. Doi : 10.1001/jamasurg.2025.0866.