Original Investigation
November 29, 2023
Surgeon Sex and Health Care Costs for Patients Undergoing Common Surgical Procedures
Christopher J. D. Wallis, Angela Jerath, Khatereh Aminoltejari, et al
JAMA Surg. Published online November 29, 2023. doi:10.1001/jamasurg.2023.6031
Question Is there an association between surgeon sex and costs of surgical care?
Findings In this population-based cohort study of 1 165 711 patients, patients treated by female surgeons had lower health care costs at 30 days, 90 days, and 1 year following surgery compared with those treated by male surgeons.
Meaning In this study, patients treated by female surgeons had lower health care costs following surgery.
Abstract
Importance Prior research has shown differences in postoperative outcomes for patients treated by female and male surgeons. It is important to understand, from a health system and payer perspective, whether surgical health care costs differ according to the surgeon’s sex.
Objective To examine the association between surgeon sex and health care costs among patients undergoing surgery.
Design, Setting, and Participants This population-based, retrospective cohort study included adult patients undergoing 1 of 25 common elective or emergent surgical procedures between January 1, 2007, and December 31, 2019, in Ontario, Canada. Analysis was performed from October 2022 to March 2023.
Exposure Surgeon sex.
Main Outcome and Measure The primary outcome was total health care costs assessed 1 year following surgery. Secondarily, total health care costs at 30 and 90 days, as well as specific cost categories, were assessed. Generalized estimating equations were used with procedure-level clustering to compare costs between patients undergoing equivalent surgeries performed by female and male surgeons, with further adjustment for patient-, surgeon-, anesthesiologist-, hospital-, and procedure-level covariates.
Results Among 1 165 711 included patients, 151 054 were treated by a female surgeon and 1 014 657 were treated by a male surgeon. Analyzed at the procedure-specific level and accounting for patient-, surgeon-, anesthesiologist-, and hospital-level covariates, 1-year total health care costs were higher for patients treated by male surgeons ($24 882; 95% CI, $20 780-$29 794) than female surgeons ($18 517; 95% CI, $16 080-$21 324) (adjusted absolute difference, $6365; 95% CI, $3491-9238; adjusted relative risk, 1.10; 95% CI, 1.05-1.14). Similar patterns were observed at 30 days (adjusted absolute difference, $3115; 95% CI, $1682-$4548) and 90 days (adjusted absolute difference, $4228; 95% CI, $2255-$6202).
Conclusions and Relevance This analysis found lower 30-day, 90-day, and 1-year health care costs for patients treated by female surgeons compared with those treated by male surgeons. These data further underscore the importance of creating inclusive policies and environments supportive of women surgeons to improve recruitment and retention of a more diverse and representative workforce.
