Operative Mortality for Male Versus Female Surgeons: A Systematic Review and Meta-Analysis

Introduction: This systematic review synthesizes published data concerning whether there is a difference in mortality rate for patients operated on by female surgeons compared to patients operated on by male surgeons. Several studies have attempted to compare surgical outcomes, including operative mortality, of male surgeons versus female surgeons. These studies include many different surgical subspecialties and surgery types. Despite current research on this topic, there has yet to be a published systematic review and meta-analysis quantitatively synthesizing these studies’ findings on operative mortality. This systematic review objectively synthesizes the current published data regarding mortality rate for patients operated on by female surgeons as compared to male surgeons. Methods: The study included patients of any age and sex undergoing any kind of surgical procedure in North America. This review considered all studies that evaluated the performance of any type of surgical procedure by female versus male surgeons and included intraoperative or postoperative mortality as outcomes. Eligible studies were appraised for risk of bias using the Newcastle–Ottawa Scale and for quality using standardized instruments from Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information. Studies were pooled for raw outcomes for statistical meta-analysis including operative mortality counts and rates. Heterogeneity was assessed using Cochran's Q test. Statistical analyses were performed using a random effects model. A forest plot was created to compare study associations and significance. Results: The search yielded five retrospective cohort studies published between 2000 and 2018 including various surgical subspecialties. In total, 1,055,122 operations were included, performed by 6139 female surgeons and 47,666 male surgeons. There were 4176 deaths among patients operated on by female surgeons and 55,666 among patients operated on by male surgeons, respectively. Forest plot analysis found no evidence of a difference between male and female surgeon mortality rate among the studies (pooled odds ratio 0.96 [0.88-1.05]). Conclusions: All five studies provided odds ratios for mortality and four of five provided counts for mortality. There was no statistical difference in mortality between male and female surgeons among the studies.