Summary Aim To compare short-term surgical outcomes between male and female gastrointestinal surgeons in Japan. Design Retrospective cohort study. Data settings from the Japanese National Clinical Database (includes data on >95% of surgeries performed in Japan) (2013-17) and the Japanese Society of Gastroenterological Surgery. Participants Male and female surgeons who performed distal gastrectomy, total gastrectomy, and low anterior resection. Main outcome measures Surgical mortality, surgical mortality combined with postoperative complications, pancreatic fistula (distal gastrectomy/total gastrectomy only), and anastomotic leak (low anterior resection only). The association of surgeon sex with surgery-related mortality and surgical complications was examined using multivariable logistic regression models adjusted for patient, surgeon, and hospital characteristics. Results A total of 149,193 distal gastrectomy surgeries (male surgeons: 140,971 (94.5%); female surgeons: 8,222 (5.5%)); 63,417 gastrectomy surgeries (male surgeons: 59,915 (94.5%); female surgeons: 3,502 (5.5%)); and 81,593 low anterior resection procedures were performed (male surgeons: 77,864 (95.4%); female surgeons: 3,729 (4.6%)). On average, female surgeons had fewer postregistration years, operated on higher-risk patients, and performed fewer laparoscopic surgeries than male surgeons. No significant difference was found between male and female surgeons in the adjusted risk of surgical mortality (adjusted odds ratio 0.98 (95% confidence interval 0.74 to 1.29) for distal gastrectomy; 0.83 (0. 57 to 1.19) for total gastrectomy; 0.56 (0.30 to 1.05) for low anterior resection), surgical mortality combined with Clavien-Dindo grade ≥3 complications (adjusted odds ratio 1.03 ( 0.93 to 1.14) for distal gastrectomy; 0.92 (0.81 to 1.05) for total gastrectomy; 1.02 (0.91 to 1.15) for low gastrectomy, anterior resection), pancreatic fistula ( adjusted odds ratio 1.16 (0.97 to 1.38) for distal gastrectomy; 1.02 (0.84 to 1.23) for total gastrectomy) and anastomotic leak (adjusted odds ratio 1.04 (0.92 to 1.18) for low anterior resection). Conclusion This study found no significant adjusted risk difference in the outcomes of surgeries performed by male versus female gastrointestinal surgeons. Despite the disadvantages, female surgeons accept high-risk patients. In Japan, greater access to surgical training for female physicians is warranted. |
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The results show the same rates of death and complications, even though female surgeons are more likely to be assigned to high-risk patients. Researchers call for more opportunities for female surgeons to help reduce gender inequity
A new study published by The BMJ finds no difference in death or complication rates between male and female surgeons in Japan, even though female surgeons are more likely to be assigned to high-risk patients than male surgeons.
Researchers note that, globally, women remain a minority in the surgical field and call for more opportunities for female surgeons to help reduce gender-based inequity.
Although the number of female doctors has been increasing worldwide in recent years, women remain a minority in the surgical field.
For example, female general surgeons represented 28% (in 2019), 22% (in 2019), and 33% (in 2017) of surgeons in Canada, the US, and the UK, respectively. In Japan, the proportion of female doctors is 22%, and the proportion of female surgeons is even lower at 5.9%. However, previous studies in the US and Canada showed that the competence of female doctors and surgeons was equal to or better than that of their male counterparts.
To explore this further, researchers used the Japanese National Clinical Database (NCD), which includes data on more than 95% of surgeries performed in Japan, to compare the surgical outcomes of male and female surgeons between 2013 and 2017. .
They also examined the relationship between postoperative mortality (within 90 days of surgery) and surgical complication rates (within 30 days of surgery) and terms of surgeon licensure.
They focused on three common procedures for stomach and rectal cancer (distal gastrectomy, total gastrectomy, and low anterior resection). These were chosen because the number of female surgeons who performed these surgeries was sufficient for analysis without the individual surgeon being identified. Their analysis included 149,193 distal gastrectomy surgeries, 63,417 gastrectomy surgeries, and 81,593 low anterior resection procedures.
The researchers found that female surgeons performed only 5% of these procedures and that female surgeons were less likely to work in high-volume centers than male surgeons.
Female surgeons were more likely than male surgeons to be assigned to high-risk patients (those who were malnourished, on long-term steroids, or with more advanced-stage disease).
But despite this, the researchers found no overall differences in rates of death or surgical complications between male and female surgeons, after taking into account other patient-related factors. On average, female surgeons also had fewer postregistration years and performed fewer minimally invasive (keyhole) surgeries than male surgeons.
The researchers suggest this could be due to reduced training opportunities linked to preferential treatment of male trainees and the competing demands of women’s traditional social roles, including raising a family.
This is an observational study , so no firm conclusions can be drawn about cause and effect, and researchers cannot rule out the possibility that the results are due to other unmeasured factors.
They also point out the lack of details about surgeons’ work and personal living conditions, and say the results may not apply to other types of surgical procedures or performed by surgeons with other specialties.
However, the strengths of the study included the use of a highly accurate clinical database in terms of the preoperative condition and surgical outcomes of the patients, and the consideration of important patient-related factors for the individual procedures selected.
“Many aspects can impair the successful development of female surgeons,” say the researchers. “However, in this analysis, there was no significant difference in the mortality or complication rates of surgeries performed by male and female surgeons, suggesting that they are equally successful in developing their surgical skills.”
They add: "More appropriate and effective surgical training for female surgeons could further improve surgical outcomes."
The challenges faced by female surgeons in Japan are not unique, and many female surgeons elsewhere have had similar experiences, notes Cherry Koh, an Australia-based colorectal surgeon, in a linked editorial.
Change at work, at home and at a societal level is necessary to support women in the workforce, it says, while leadership at all levels is crucial to drive change, including commitment from government ministers, professional surgical societies, hospital managers and departmental leaders.
Only through broad commitment can national regulations (such as targets or quotas that support gender equity in recruitment, training and retention) be combined with local measures (such as codes of conduct, safer work practices and job opportunities). tutoring),” he writes. “Quick change is needed, in the interests of both doctors and patients.”
