Original Investigation
April 23, 2025
Long-Term Postoperative Outcomes by Surgeon Gender and Patient-Surgeon Gender Concordance in the US
Ryo Ikesu, Hiroshi Gotanda, Tara A. Russell, et al
JAMA Surg. Published online April 23, 2025. doi:10.1001/jamasurg.2025.0866
Question Are long-term postoperative outcomes different by surgeon gender and patient-surgeon gender concordance?
Findings In this cross-sectional study of 2 288 279 Medicare fee-for-service beneficiaries who underwent 1 of 14 major surgeries, it was found that female surgeons had better long-term outcomes compared with male surgeons for both female and male patients. Female patients treated by female surgeons experienced lower long-term readmission and complication rates compared with those treated by male surgeons, whereas long-term readmission and complication rates did not differ between female vs male surgeons for male patients.
Meaning These findings suggest that compared with male surgeons, female surgeons had better long-term patient outcomes, especially for female patients.
Abstract
Importance Evidence suggests that physician gender and patient-physician gender concordance have the potential to improve patient outcomes, especially for female patients. However, whether long-term outcomes differ by surgeon gender and patient-surgeon gender concordance has not been studied in the US.
Objective To compare long-term postoperative outcomes by surgeon gender and patient-surgeon gender concordance.
Design, Setting, and Participants A population-based cross-sectional study was conducted based on 100% Medicare fee-for-service claims data from 2016 through 2019. Data analysis was performed between October 17, 2023, and January 28, 2025. The study took place at acute care hospitals in the US. Participants included Medicare fee-for-service beneficiaries aged 65 to 99 years who underwent 1 of 14 elective or emergent surgeries.
Exposures Surgeon gender and patient-surgeon gender concordance.
Main Outcomes and Measures Ninety-day and 1-year postoperative mortality, readmission, and complication rates were compared by surgeon gender and patient-surgeon gender concordance. The study team adjusted for patient and surgeon characteristics and hospital fixed effects, effectively comparing patients within the same hospital.
Results Among 2 288 279 patients who underwent surgery, 129 528 were operated on by female surgeons (5.7%) and 2 158 751 were by male surgeons (94.3%). Patients treated by female surgeons experienced a lower long-term mortality rate compared with those treated by male surgeons (adjusted 90-day mortality rates, 2.6% for female surgeons vs 3.0% for male surgeons; adjusted risk difference [aRD], −0.3 percentage points [pp]; 95% CI, −0.5 pp to −0.2 pp; P < .001), similarly for both female and male patients. For female patients, the patient-surgeon gender concordance was associated with lower long-term readmission (adjusted 90-day readmission rates, 7.3% vs 7.7%; aRD, −0.4 pp; 95% CI, −0.7 pp to −0.2 pp; P = .001) and complication rates (adjusted 90-day complication rates, 12.2% vs 12.8%; aRD, −0.5 pp; 95% CI, −0.9 pp to −0.2 pp; P = .005). For male patients, long-term readmission and complication rates did not differ between patients treated by female vs male surgeons. Similar patterns were found between 90-day and 1-year patient outcomes.
Conclusions and Relevance In this study, both female and male patients treated by female surgeons experienced lower long-term postoperative mortality rates compared with those treated by male surgeons. Patient-surgeon gender concordance was associated with lower long-term readmission and complication rates for female patients, but not for male patients. These patterns were observed only for elective procedures and may not be generalizable to other populations, such as younger patients.
