Are Women Better Surgeons Than Men?

ARTICLE INFORMATION Blohm M, Sandblom G, Enochsson L, Österberg J. Are women better surgeons than men? JAMA Surg 2023:3741. BACKGROUND Surgery has always remained a male-dominated branch, but in recent times, this has changed and more female surgeons are taking up this speciality. However, females in all surgical fields still remain a minority. Whether there are any differences in operative outcomes between male and female surgeons has long been debated. The female surgeon is generally thought to be more empathetic, patient-centred and technically meticulous, whereas males are thought to be faster operators but with a more ‘rash’ approach. It has not been carefully investigated whether gender actually affects a patient’s outcome after an operation is done by a female or male and whether this is just another instance of stereotyping. Blohm et al. in a study published in JAMA Surgery investigated whether there were actual differences in the operative results between male and female surgeons and the reasons for this and thereby try to answer the perception of gender inequality in surgical performance.[1] They investigated the differences in cholecystectomy outcomes and operating times between male and female surgeons in 150 509 patients who had undergone operations in Swedish hospitals between 1 January 2006 and 31 December 2019. Amongst the operations conducted, one-third (33%) were conducted by female surgeons and two-thirds (67%) by male surgeons. The intraoperative time taken was greater in females than males (the mean difference in operating time between female and male surgeons was 7.96 min for all surgeries with P < 0.001). The mean operating time for female surgeons was 100 min in elective surgery and 126 min in acute care surgery versus 89 min in elective and 111 min in acute care surgery for male surgeons. However, the complication rates (3.3% for females and 4.3% for males, P < 0.001) and the length of hospital stay (9.3% for females and 11.4% for males, P < 0.001) were greater in male surgeons. Females had fewer bile duct injuries and converted to open surgery less frequently in the acute care setting. The authors concluded that in acute and elective cholecystectomies, when compared to male surgeons, female surgeons operated more slowly but had more favourable outcomes. COMMENTARY This article attempts to answer whether there was any correlation between the gender of the surgeon with the operative outcome and the complication rates. The authors examined the results of more than 15 thousand laparoscopic cholecystectomies performed by 849 female surgeons and 1704 male surgeons and found that female surgeons had more favourable outcomes and less complication rates although their operative time was higher. A similar Canadian study by Wallis et al. reported small differences in post-operative outcomes between patients treated by female and male surgeons but with those treated by female surgeons having a significantly lower rate of 30-day mortality (480 out of 52,315 patients operated by female surgeons versus 543/52,315 patients operated by male surgeon, P = 0.04).[2] Another study by Tsugawa et al. showed equal mortality rates for female and male surgeons.[3] A systematic review on surgical skills concluded that female medical students were slower but had higher precision.[4] A recently published Japanese study found no difference in post-operative outcomes for female and male surgeons in major general surgery.[5] One of the major drawbacks of these studies is that they did not include the age or experience of the surgeon in laparoscopic surgery which would help in understanding the results better. The main reasons for the increased complication rate in male surgeons may have been their higher confidence levels and their risk-taking behaviour. Female surgeons seemed to have longer operative times but were deemed to be more precise, cautious and patient-centric which might have led to better outcomes and fewer complications. Gender inequality exists at multiple levels in medicine with fewer female surgeons entering surgical specialities and a lower likelihood for them to secure consultant positions after completion of residency according to studies. A preferential referral to male surgeons by their male colleagues has also been noted.[6] A study by Burgos Carmen et al. has shown that only few female residents opted for surgical fields due to a lack of role models and mentors.[7,8] A surgeon should be given equal opportunities to develop the skills required to provide the best possible patient care and a good surgical outcome. A sound knowledge of the procedure, surgical anatomy and confident decision-making should be the basis of surgical practice. The well-established attributes of a surgeon that lead to a better outcome are precision, positive attitude towards feedback, careful patient selection, patient-centred communication and a willingness to collaborate. Hence, we feel that the main focus should be on inculcating the right attitudes and skill sets rather than furthering gender-specific biases. Equal opportunities, encouragement, a healthy learning atmosphere and guidance to the newer generations of surgeons will pave the way for better patient care and improvement of surgical techniques. It is also important to create an unbiased working environment based on merit and not gender to encourage more females to take up surgery. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.