Objective:
To evaluate the associations between surgeon-patient sex concordance, long-term clinical outcomes and healthcare costs.
Background Data:
Emerging data suggest surgeon-patient sex concordance may improve short-term outcomes, especially for female patients, yet its long-term effects remain unknown.
Methods:
We conducted a population-based retrospective cohort study of adults undergoing common surgeries in Ontario, Canada (2007-2019). Patients were followed for 90 and 365 days. Surgeon-patient sex concordance was categorized into four dyads. Multivariate generalized estimating equations clustered by procedure type evaluated composite and individual (complications, readmission, mortality) clinical outcomes and healthcare costs.
Results:
A total of 1,165,711 patients were included. Female patients treated by male surgeons, compared with female surgeons, were more likely to experience an adverse composite event (90 d: aOR 1.12, 95% CI 1.08–1.17, P<0.001; 365 d: aOR 1.09, 95% CI 1.05–1.14, P<0.001), with no association among male patients (90 d: aOR 1.00, 95% CI 0.94–1.05, P=0.89; 365 d: 0.99, 95% CI 0.92–1.07,P=0.87). Long-term total healthcare costs were greater for patients treated by male surgeons – an effect seen in both male patients (90 d: aRR 1.08, 95% CI 1.03-1.14, P=0.002 and 365 d: aRR 1.08, 95% CI 1.02-1.14, P=0.007) and female patients (90 d: aRR 1.10, 95% CI 1.05-1.14, P<0.001, 365 d: aRR 1.09, 95% CI 1.05-1.14, P<0.001).
Conclusions:
Surgeon-patient sex concordance was associated with improved long-term outcomes for female, but not male, patients, and female surgeons’ patients had lower healthcare costs. Given these benefits, further investigation into the mechanisms driving these outcomes is warranted.
