Long-Term Postoperative Outcomes by Surgeon Gender and Patient-Surgeon Gender Concordance in the US

Abstract

ImportanceEvidence 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.ObjectiveTo compare long-term postoperative outcomes by surgeon gender and patient-surgeon gender concordance.Design, Setting, and ParticipantsA population-based cross-sectional study was 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.ExposuresSurgeon gender and patient-surgeon gender concordance.Main Outcomes and MeasuresNinety-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.ResultsAmong 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 < .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 = .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 = .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 RelevanceIn 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.