Introduction

Female surgeons are still in the minority worldwide and highlighting gender differences in surgery is important in understanding and reducing inequities within the surgical specialty (1). Studies on different surgical procedures indicates equal results, or safer outcomes, for female surgeons (2-4) but it is still unclear whether female and male surgeons differ in surgical outcomes in gallstone surgery .

Aims & Methods

The aim of this study was to determine whether female and male surgeons differ in surgical outcomes and operating time in elective and acute cholecystectomy, one of the most frequently performed surgical procedures. A registry-based cohort study was performed, based on the Swedish Registry of Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks). All laparoscopic and open cholecystectomies registered between 2006 and 2019 were included. The follow-up time was 30 days. The association between the surgeon’s gender and surgical outcomes was calculated with generalized estimated equations, for elective and acute cholecystectomies. Differences in operating time was calculated with mixed linear model analysis. The patient’s age, sex, and American Society of Anesthesiologist (ASA) grade, previous cholecystitis, hospital size and the surgeon’s annual operative volume were considered as potential confounders and included in the multivariable analyses. In addition, days from hospital admission to surgery was included for acute operations.

Results

The analysis included 150,509 patients undergoing cholecystectomy: 97,755 (64.9%) elective and 52,754 (35.1%) acute operations. The procedures were performed by 2,553 surgeons of whom 849 (33.3%) were female and 1,704 (67.7%) were male. The proportion of female surgeons increased during the study period. Female surgeons performed less cholecystectomies per year compared to male surgeons, and they were somewhat more represented at universities and private clinics. Male surgeons had more surgical complications (OR 1.29, 95% CI 1.19 to 1.40) and total complications (OR 1.12, 95% CI 1.06 to 1.19). They also caused more bile duct injuries in elective surgery (OR 1.69, 95% CI 1.22 to 2.34), but no significant difference could be demonstrated in acute operations. Male surgeons converted to open surgery more often than female surgeons in acute surgery (OR 1.22, 95% CI 1.04 to 1.43) and their patients had longer hospital stays (OR 1.21, 95% CI 1.11 to 1.31). No significant difference in 30-day mortality could be demonstrated. Female surgeons had significantly longer operation times in both elective and acute cholecystectomies.

Conclusion

The results indicate that female surgeons have more favorable outcomes and operate more slowly than male surgeons in elective and acute cholecystectomies. Elective operations are complicated less frequently by a bile duct injury when the lead surgeon is female. These findings may contribute to an increased understanding of gender differences within the surgical specialty.

References

1. Xepoleas MD, Munabi NCO, Auslander A, Magee WP, Yao CA. The experiences of female surgeons around the world: a scoping review. Hum Resour Health. Oct 28 2020;18(1):80.
2. Okoshi K, Endo H, Nomura S, et al. Comparison of short term surgical outcomes of male and female gastrointestinal surgeons in Japan: retrospective cohort study. BMJ. Sep 28 2022;378:e070568.
3. Wallis CJ, Ravi B, Coburn N, Nam RK, Detsky AS, Satkunasivam R. Comparison of postoperative outcomes among patients treated by male and female surgeons: a population based matched cohort study. BMJ. Oct 10 2017;359:j4366.
4. Sharoky CE, Sellers MM, Keele LJ, et al. Does Surgeon Sex Matter?: Practice Patterns and Outcomes of Female and Male Surgeons. Ann Surg. Jun 2018;267(6):1069-1076.

Disclosure

Gabriel Sandblom, Lars Enochsson and Johanna Österberg are unpaid members of the leadership board of GallRiks. Gabriel Sandblom has granted an honorarium as specialty chief editor for Frontiers in Surgery. My Blohm has no conflicts of interest or financial ties to disclose.