Do male and female surgeons differ in patient morbidity or mortality outcomes, or in overall competence?

Surgeon Gender and Patient Outcomes

Female surgeons achieve equivalent or slightly superior patient outcomes compared to male surgeons, with the most recent and comprehensive evidence showing clinically marginal differences that should not influence surgeon selection.

Key Evidence on Patient Outcomes

The highest quality and most recent evidence demonstrates that surgeon gender has minimal clinical impact on patient outcomes:

Mortality and Morbidity Outcomes

In the largest contemporary analysis of nearly 5 million patients across 39 surgical procedures (2016-2021), surgeon gender showed only small statistical differences that were not clinically meaningful. 1 After propensity matching, the primary composite outcome (death, complications, or readmission) occurred in 12.9% of female surgeon patients versus 13.0% of male surgeon patients (OR 1.02,95% CI: 1.01-1.03), representing a difference too small to guide clinical decision-making. 1

• A 2023 Medicare analysis of over 2.9 million surgical patients found adjusted 30-day mortality rates were similar across all patient-surgeon gender combinations, with differences that were "small and not clinically meaningful." 2
• Female patient-female surgeon dyads had 1.3% mortality, male patient-male surgeon dyads had 2.0% mortality, but these differences largely reflected patient characteristics rather than surgeon competence. 2

Surgical Competence and Practice Patterns

When female and male surgeons with similar characteristics operate at the same hospital on similar patients, their outcomes are equivalent. 3

• A matched analysis of 2,462 surgeons at 429 hospitals found that after controlling for surgeon age, experience, and hospital, female and male surgeons had equivalent rates of mortality, complications, and prolonged length of stay. 3
• In a study of over 100,000 surgical patients, female surgeons had fewer patient deaths, readmissions, and complications within 30 days after surgery when patients were matched for age, comorbidities, hospital, and surgeon experience. 4

Important Contextual Factors

Specialty-Specific Considerations

The association between surgeon gender and outcomes varies inconsistently across surgical specialties, suggesting the relationship is not causal:

• Procedure-specific analyses revealed inconsistent or absent surgeon-gender associations, indicating that observed differences likely reflect practice patterns, patient selection, or unmeasured confounders rather than inherent competence differences. 1
• In carotid endarterectomy specifically, historical data showed women patients had higher operative risk (10.4% versus 5.8% for men in ECST), but this reflected patient characteristics rather than surgeon gender. 4

Surgeon Demographics and Experience

Female surgeons in current practice tend to be younger with less clinical experience, which can confound outcome comparisons:

• Female surgeons averaged 45±9 years of age versus 53±11 years for male surgeons, with correspondingly lower operative volumes. 1
• Before matching for experience and hospital, female surgeons showed better unadjusted outcomes, but these differences largely disappeared after appropriate risk adjustment. 3, 1

Clinical Implications

Patient Selection of Surgeons

Patients should select surgeons based on experience, specialty expertise, and individual qualifications rather than gender, as surgeon gender alone does not have clinically meaningful impact on outcomes. 1

• The evidence consistently demonstrates that when appropriately matched for experience and practice setting, male and female surgeons achieve equivalent results. 3, 2, 1
• Small statistical differences observed in large datasets do not translate to clinically significant differences that should guide individual patient decisions. 2, 1

Workforce Diversity Considerations

While surgeon gender does not meaningfully affect individual patient outcomes, workforce diversity offers broader benefits:

• A diverse surgical workforce strengthens organizational strategies and decision-making processes through varied perspectives. 4
• Female physicians demonstrate superior counseling and communication styles as perceived by patients, though technical outcomes remain equivalent. 5
• Women remain significantly underrepresented in surgery, comprising only 25% of board-certified surgeons as of 2013, with even lower representation in neurosurgery (1:10.6 female-to-male ratio) and orthopedic surgery (1:13.9 ratio). 6

Common Pitfalls to Avoid

• Do not assume gender concordance improves outcomes: The 2023 Medicare study found no clinically meaningful benefit from patient-surgeon gender concordance for either elective or non-elective procedures. 2
• Do not conflate statistical significance with clinical significance: Large datasets can detect tiny differences that have no practical impact on individual patient care. 2, 1
• Do not ignore experience and volume: Surgeon experience, operative volume, and hospital quality are far more important determinants of outcomes than surgeon gender. 3, 1