E. Londono1, W. Weng2, K. Bishop2, M. Englesbe2 1University Of Michigan, Medical School, Ann Arbor, MI, USA 2University Of Michigan, Transplant Surgery, Ann Arbor, MI, USA
Introduction: It is well known that surgical outcomes can differ based on the sex of the patient. Our goal was to determine whether there was a relationship between provider-patient sex discordance and post-operative complications.
Methods: We analyzed surgical outcomes following elective colectomy and hernia repair between 01/01/2019-10/16/2021 with the Michigan Surgical Quality Collaborative database. Primary outcome was the occurrence of any major surgical complication. We focused on four main groups: 1. Male surgeon and male patient (MSMP) 2. Male surgeon and female patient (MSFP) 3. Female surgeon and male patient (FSMP) and 4. female surgeon and female patient (FSFP). We then performed a Glimmix procedure including the patient/provider combination group, patient age, race, insurance type, patient comorbidities, wound class, surgical approach as the fixed effects while hospital and surgeon served as the random intercept.
Results: A total of 5337 patients underwent elective hernia repair: 2894 were female and 2443 were male patients. There was a total of 30 (14%) female and 188 (86%) male surgeons. Male providers performed 4733 (89%) of the surgeries. Of the surgeries performed by male providers, 2218 (47%) were on males and 2515 (53%) were on female patients. Female providers performed 604 (11%) of the surgeries. Of the surgeries performed by female providers, 225 (37%) were on males and 379 (63%) were on female patients. The complication rates amongst the four groups are 2.66% (FSFP), 5.34% (MSFP), 3.44% (MSMP), and 4.19% (FSMP). The results found that MSMP had lower complication rate than MSFP (odds ratio=0.6, 95% CI: 0.4-0.84). Hernia repairs on male patients, regardless of the surgeon’s sex, was associated with a lower complication rate (odds ratio=0.632, 95% CI: 0.46-0.87). There was no statistically significant difference among other groups. A total of 1056 patients underwent elective colectomy: 577 were female patients and 479 were male patients. There was a total of 8 (13%) female and 55 (87%) male surgeons. Male providers performed 953 (90%) of the surgeries. Of the surgeries performed by male providers, 436 (46%) were on males and 517 (54%) were on female patients. Female providers performed 103 (11%) of the surgeries. Of the surgeries performed by female providers 43 (42%) were on males and 60 (58%) were on female patients. The complication rates amongst the four groups are 26.7% (FSFP), 30% (MSFP), 29.1% (MSMP) and 25.6% (FSMP). There was no statistically significant difference among the groups.
Conclusion: Female surgeons make up a low percentage of surgeons in Michigan and are more likely to treat female patients. In this study, there was no significant relationship between provider-patient sex discordance and post-operative complications of elective colectomies. There was a lower complication rate following elective hernias among MSMP compared to MSFP; cause of this difference is unclear.