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

The use of pulmonary artery catheter and clinical outcomes in older adults with cardiogenic shock

BACKGROUND

Evidence is lacking regarding the benefits of pulmonary artery catheter (PAC) for cardiogenic shock (CS).

METHODS

We analyzed the data on Medicare fee-for-service beneficiaries aged 65-99 admitted with CS from 2016 to 2020 to compare outcomes of patients monitored with versus without PAC. We implemented propensity score matching weight (PSMW) analysis with hospital fixed effects (effectively comparing outcomes within the same hospital) and quasi-experimental instrumental variable (IV) analysis (accounting for potential unmeasured confounders) with the probability of using PAC for CS in the previous year as the instrument.

RESULTS

We included 4668 and 78,502 patients admitted with CS, monitored with and without PAC, respectively. We found no evidence that the use of PAC was associated with mortality either in PSMW (adjusted absolute risk difference [aRD], +0.5-percentage-points [pp]; 95 % confidence interval [CI], -1.1 to +2.1) or IV (aRD, -2.5 pp.; 95 % CI, -8.2 to +3.2) analyses. While consistent associations were not observed between the use of PAC and major bleeding and sepsis, the use of PAC was associated with a higher risk of all-bleeding (PSMW: aRD, +1.5 pp.; 95 % CI, +0.1 to +2.9; IV: +13.3 pp.; 95 % CI, +7.7 to +18.8) and longer LOS (PSMW: adjusted mean difference, +1.6 days; 95 % CI, +1.1 to +2.0; IV: +6.9 days; +4.9 to +9.0).

CONCLUSIONS

We found no evidence that the use of PAC was associated with lower mortality in patients with CS. While high-quality randomized trials are needed, providers should be careful about appropriate settings and indications of the use of PAC for the management of CS.

Association Between Surgeon Sex and Days Alive at Home Following Surgery: A Population-Based Cohort Study

Objective

The objective of this study was to measure potential associations between surgeon sex and number of days alive and at home (DAH).

Background

Patients treated by female surgeons appear to have lower rates of mortality, complications, readmissions, and healthcare costs when compared with male surgeons. DAH is a validated measure, shown to better capture the patient experience of postoperative recovery.

Methods

We conducted a retrospective study of adults (≥18 years of age) undergoing common surgeries between January 01, 2007 and December 31, 2019 in Ontario, Canada. The outcome measures were the number of DAH within 30-, 90-, and 365-days. The data was summarized using descriptive statistics and adjusted using multivariable generalized estimating equations.

Results

During the study period, 1,165,711 individuals were included, of which 61.9% (N = 721,575) were female. Those managed by a female surgeon experienced a higher mean number of DAH when compared with male surgeons at 365 days (351.7 vs. 342.1 days; P < 0.001) and at each earlier time point. This remained consistent following adjustment for covariates, with patients of female surgeons experiencing a higher number of DAH at all time points, including at 365 days (343.2 [339.5-347.1] vs. 339.4 [335.9-343.0] days). Multivariable regression modeling revealed that patients of male surgeons had a significantly lower number of DAH versus female surgeons.

Conclusions

Patients of female surgeons experienced a higher number of DAH when compared with those treated by male surgeons at all time points. More time spent at home after surgery may in turn lower costs of care, resource utilization, and potentially improve quality of life. Further studies are needed to examine these findings across other care contexts.

The joy of surgery: how gender influences surgeons' experiences

INTRODUCTION

Burnout in medicine is an epidemic, and surgeons are not immune. Studies often focus on negative factors leading to burnout, with less emphasis on optimizing joy. The purpose of this study, conducted by the SAGES Reimagining the Practice of Surgery Task Force, was to explore how gender may influence surgeon well-being to better inform organizational change.

METHODS

The study team developed a survey with the domains: facilitators of joy, support for best work, time for work tasks, barriers to joy, and what they would do with more time. The survey was emailed to 5777 addresses on the SAGES distribution list. Results were analyzed by calculating summary statistics.

RESULTS

223 surgeons completed the survey; 62.3% identified as men, 32.3% as women, and 5.4% did not indicate gender. Female compared to male respondents were younger (41.6 vs 52.5 years) and had practiced for fewer years (8.4 vs 19.4 years). The three greatest differences in facilitators of joy were being a leader in the field, leading clinical teams, and teaching, with a > 10 percentage point difference between men/women rating these highly (score of ≥ 8). Women generally perceived less support from their institutions than men. The greatest gender difference was in support for teaching, with 52.8% of men rating this highly compared to 30.2% of women. Only 52% of women felt respected by coworkers most of the time compared to 68.3% of men. Most (96.0%) respondents (men 95.7% and women 98.6%) reported wanting more time with family and friends.

CONCLUSION

This study demonstrates the complexity of the personal and professional factors that influence joy in surgery, highlight gender differences that impact joy and suggests opportunities for improved gender-based support. These results can inform potential organization-level changes and further research to better understand emerging differences in joy across gender identities.

Comparison of Hospital Mortality and Readmission Rates by Physician and Patient Sex

BACKGROUND

Little is known as to whether the effects of physician sex on patients' clinical outcomes vary by patient sex.

OBJECTIVE

To examine whether the association between physician sex and hospital outcomes varied between female and male patients hospitalized with medical conditions.

DESIGN

Retrospective observational study.

SETTING

Medicare claims data.

PATIENTS

20% random sample of Medicare fee-for-service beneficiaries hospitalized with medical conditions during 2016 to 2019 and treated by hospitalists.

MEASUREMENTS

The primary outcomes were patients' 30-day mortality and readmission rates, adjusted for patient and physician characteristics and hospital-level averages of exposures (effectively comparing physicians within the same hospital).

RESULTS

Of 458 108 female and 318 819 male patients, 142 465 (31.1%) and 97 500 (30.6%) were treated by female physicians, respectively. Both female and male patients had a lower patient mortality when treated by female physicians; however, the benefit of receiving care from female physicians was larger for female patients than for male patients (difference-in-differences, -0.16 percentage points [pp] [95% CI, -0.42 to 0.10 pp]). For female patients, the difference between female and male physicians was large and clinically meaningful (adjusted mortality rates, 8.15% vs. 8.38%; average marginal effect [AME], -0.24 pp [CI, -0.41 to -0.07 pp]). For male patients, an important difference between female and male physicians could be ruled out (10.15% vs. 10.23%; AME, -0.08 pp [CI, -0.29 to 0.14 pp]). The pattern was similar for patients' readmission rates.

LIMITATION

The findings may not be generalizable to younger populations.

CONCLUSION

The findings indicate that patients have lower mortality and readmission rates when treated by female physicians, and the benefit of receiving treatments from female physicians is larger for female patients than for male patients.

PRIMARY FUNDING SOURCE

Gregory Annenberg Weingarten, GRoW @ Annenberg.

Analysis of Barbie medical and science career dolls: descriptive quantitative study

OBJECTIVES

To identify Barbie brand dolls that had medicine and science themed professions in comparison with other career dolls and to determine their accuracy in meeting clinical and laboratory safety standards.

DESIGN

Descriptive quantitative study.

SETTING

Visual and data analysis of web searches.

MAIN OUTCOME MEASURES

To identify the kinds of medical and scientific subspecialties that the Barbie dolls (and a comparison doll group) worked in; and to determine whether these medical professional and scientist dolls met laboratory and clinical safety standards. Additional data about doll demographics (ie, age, ethnic group, and sex) were also collected.

PARTICIPANTS

92 Barbie brand dolls were analyzed: doctor (n=53), scientist (n=10), science educator (n=2), nurse (n=15), dentist (n=11), and paramedic (n=1). 65 non-Barbie brand dolls were also analyzed for comparison purposes: doctor (n=26), scientist (n=27), nurse (n=7), dentist (n=2), engineer (n=2), and magnetic resonance imaging (MRI) technician (n=1) dolls.

RESULTS

Barbie brand medical professional dolls (n=80) largely treated children (66%, n=53/80), with only three (4%) medical professional dolls being directly depicted working with adults. Of the 12 scientist Barbie brand dolls, none met all proper personal protective equipment requirements related to hair and clothing. Barbie brand dolls often came with items, such as laboratory coats, microscopes, stethoscopes, and glasses, that children stereotypically associate with doctors and scientists. While comparison dolls offered a wider range of age and ethnic groups than the Barbie doll group did, the dolls similarly struggled to portray a wide range of medical and scientific subfields and most comparison dolls did not wear proper personal protective equipment.

CONCLUSIONS

Medicine and science themed dolls help to inspire tomorrow's medical professionals and scientists. All toy companies should ensure that future medical professional and scientist dolls meet clinical and laboratory safety standards and diversify the types of medical and scientific professions represented (especially among male dominated fields). For young girls' sakes as much as her own, Barbie must keep shattering glass ceilings.