Association between patient-surgeon gender concordance and mortality after surgery in the United States: retrospective observational study.

Autor:	Wallis CJ; Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada.; Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada.; Division of Urology, Department of Surgery, University Health Network, Toronto, ON, Canada., Jerath A; Department of Anesthesia, Sunnybrook Health Sciences Center, Toronto, ON, Canada., Ikesu R; Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.; Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA., Satkunasivam R; Department of Urology, Houston Methodist Hospital, Houston, TX, USA.; Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, USA.; Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX, USA., Dimick JB; Department of Surgery, University of Michigan, Ann Arbor, MI, USA., Orav EJ; Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA., Maggard-Gibbons M; Department of Surgery, University of California Los Angeles, Los Angeles, CA, USA., Li R; Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA., Salles A; Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA., Klaassen Z; Division of Urology, Medical College of Georgia-Augusta University, Augusta, GA, USA., Coburn N; Department of Surgery, Sunnybrook Health Sciences Center, Toronto, ON, Canada.; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada., Bass BL; George Washington University, School of Medicine and Health Sciences, Washington, DC, USA., Detsky AS; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.; Department of Medicine, University of Toronto, Toronto, ON, Canada.; Department of Medicine, Mount Sinai Hospital and University Health Network, Toronto, ON, Canada., Tsugawa Y; Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA ytsugawa@mednet.ucla.edu.; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
Jazyk:	angličtina
Zdroj:	BMJ (Clinical research ed.) [BMJ] 2023 Nov 22; Vol. 383, pp. e075484. Date of Electronic Publication: 2023 Nov 22.
DOI:	10.1136/bmj-2023-075484
Abstrakt:	Objective: To determine whether patient-surgeon gender concordance is associated with mortality of patients after surgery in the United States. Design: Retrospective observational study. Setting: Acute care hospitals in the US. Participants: 100% of Medicare fee-for-service beneficiaries aged 65-99 years who had one of 14 major elective or non-elective (emergent or urgent) surgeries in 2016-19. Main Outcome Measures: Mortality after surgery, defined as death within 30 days of the operation. Adjustments were made for patient and surgeon characteristics and hospital fixed effects (effectively comparing patients within the same hospital). Results: Among 2 902 756 patients who had surgery, 1 287 845 (44.4%) had operations done by surgeons of the same gender (1 201 712 (41.4%) male patient and male surgeon, 86 133 (3.0%) female patient and female surgeon) and 1 614 911 (55.6%) were by surgeons of different gender (52 944 (1.8%) male patient and female surgeon, 1 561 967 (53.8%) female patient and male surgeon). Adjusted 30 day mortality after surgery was 2.0% for male patient-male surgeon dyads, 1.7% for male patient-female surgeon dyads, 1.5% for female patient-male surgeon dyads, and 1.3% for female patient-female surgeon dyads. Patient-surgeon gender concordance was associated with a slightly lower mortality for female patients (adjusted risk difference -0.2 percentage point (95% confidence interval -0.3 to -0.1); P<0.001), but a higher mortality for male patients (0.3 (0.2 to 0.5); P<0.001) for elective procedures, although the difference was small and not clinically meaningful. No evidence suggests that operative mortality differed by patient-surgeon gender concordance for non-elective procedures. Conclusions: Post-operative mortality rates were similar (ie, the difference was small and not clinically meaningful) among the four types of patient-surgeon gender dyads. Competing Interests: Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare: support from the National Institute on Minority Health and Health Disparities and Gregory Annenberg Weingarten GRoW @Annenberg for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work. (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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