Complications are greater in women operated on by men, study says

Women who have surgery performed by men are more susceptible to complications after the procedure than men who are operated on by women, suggests a study published in the journal Jama Surgery. In addition, complications in female patients were lower in cases where they were operated on by another woman.

The researchers analyzed data from patients who had a surgical procedure in order to understand post-surgery outcomes considering the gender of both patients and surgeons.

The study was conducted through the analysis of population data from the city of Ontario, Canada. In total, more than 1 million patients were listed, in addition to nearly 3,000 surgeons.

To be considered an operation-related setback, death, readmission, or surgical complications were required within 30 days.

With this data, the researchers cross-referenced the gender information of patients and physicians to see if there was a correlation between these two factors and a higher prevalence of problems after surgery.

It was observed that, in women who had their operations performed by men, the outcomes were more complicated compared to other groups — men operated on by women and patients who had the surgery performed by a doctor of the same sex.

The finding does not necessarily indicate that the complications pervade gender bias, says Christopher Wallis, assistant professor in the division of urology at the University of Toronto and one of the authors of the research. “This study evaluated epidemiological associations rather than proving the way in which they happened,” he says.

Still, the researchers say there are some hypotheses and one of them actually concerns unconscious gender biases. According to Wallis, this type of attitude concerns “when we act [baseados em] Prejudices, stereotypes and subconscious attitudes [que são] deeply rooted”.

The researchers also raise the suspicion, based on previous research, that symptoms reported by females are more underestimated, especially among male physicians. “Thus, early symptoms of complications can go unnoticed when they can be mitigated, and instead manifest as more serious events,” explains Wallis.

Another hypothesis to explain the research finding is communication between the parties. Wallis says other studies have observed that “men and women have different communication skills.” This could result, for example, in not very adequate communication between patient and doctor, causing postoperative complications to be less considered in their case.

In addition, the researchers say that other studies have already investigated how there is a certain preference of patients for doctors with similar sociodemographic profiles. For example, black people would be more likely to opt for black doctors — having more positive results in these consultations when compared to those performed by white specialists.

However, an existing dilemma is that, in the field of surgeons, there is still little diversity. In this study, of all the surgeries analyzed, only 18% were performed by women.

Racial representation also falls short of what it could be. Another article also published recently in Jama Surgery analyzed data from applications, enrollments and graduations in surgical residency programs in the United States. Of more than 70,000 applications, only 8% were from black people.

In Brazil, the scenario is not very different. Data from the Medical Demography 2020 study indicate that women are still underrepresented in the most diverse surgical specialties, although the presence of female doctors has increased.

“Even if there are characteristics that can lead men to prefer surgery more, there is also discrimination and, let’s say, greater difficulty for women to access surgical specializations”, says Mario Scheffer, professor at the USP School of Medicine (University of São Paulo ).

Scheffer, who is the principal investigator for Medical Demography 2020, is also a co-author of another survey recently published in the Journal of Surgical Research on the presence of women specializing in some type of surgery in Brazil. According to him, there was a greater increase in women entering this medical career, but even so this “grew close to the immense inequality that existed”.

On the racial issue, there is a desert of information, both for surgeons and for doctors of other specialties. In Medical Demography 2020, for example, there is no data on race or color because these are elements that are not consolidated across the country.

“This invisibility of race and color information in medical administrative data is revealing that it is a very advanced topic,” says Scheffer.

Difficulty for them

Since 1994, Tatiana Novais, 48, has had surgery centers as her second home, but that reality is not so common for people like her​—a black woman.

Novais is a plastic surgeon and has also specialized in general and craniomaxillofacial surgery. She reports that, from the beginning of her medical career, she realized that the issue of gender was a problem.

“This difficulty starts more for women. We are now in a situation that is completely changing: there are more women accessing college, there are more women entering the residency, but in my time there were much less”, he says.

One of those situations that Novais went through was hearing from a professor that the problem in the surgical area was that it had started to accept women. “It was a prejudice, but it was not veilable, it was wide open”, says Novais.