Download PDF
CC BY-NC-ND 4.0 · Thorac Cardiovasc Surg 2025; 73(03): 206-213
DOI: 10.1055/s-0044-1786182
Original Cardiovascular

Female Surgeons in Cardiac Surgery: Does the Surgeon's Gender Affect the Outcome of Routine Coronary Artery Bypass Graft and Isolated Aortic Valve Surgery?

Viyan Sido
1   Department of Cardiovascular Surgery, Heart Center Brandenburg, University Hospital Brandenburg Medical School, Faculty of Health Sciences Brandenburg, Bernau, Germany
2   Paracelsus Medical University, Master Programme Public Health, Center for Public Health and Healthcare Research, Salzburg, Austria
,
Filip Schröter
1   Department of Cardiovascular Surgery, Heart Center Brandenburg, University Hospital Brandenburg Medical School, Faculty of Health Sciences Brandenburg, Bernau, Germany
,
Jacqueline Rashvand
1   Department of Cardiovascular Surgery, Heart Center Brandenburg, University Hospital Brandenburg Medical School, Faculty of Health Sciences Brandenburg, Bernau, Germany
,
Roya Ostovar
1   Department of Cardiovascular Surgery, Heart Center Brandenburg, University Hospital Brandenburg Medical School, Faculty of Health Sciences Brandenburg, Bernau, Germany
,
Sofia Chopsonidou
1   Department of Cardiovascular Surgery, Heart Center Brandenburg, University Hospital Brandenburg Medical School, Faculty of Health Sciences Brandenburg, Bernau, Germany
,
Johannes M. Albes
1   Department of Cardiovascular Surgery, Heart Center Brandenburg, University Hospital Brandenburg Medical School, Faculty of Health Sciences Brandenburg, Bernau, Germany
› Author Affiliations
› Further Information
  Permissions and Reprints All articles of this category

Abstract

Background The increasing presence of female doctors in the field of cardiac surgery has raised questions about their surgical quality compared to their male colleagues. Despite their success, female surgeons are still underrepresented in leadership positions, and biases and concerns regarding their performance persist. This study aims to examine whether female surgeons perform worse, equally well, or better than their male counterparts in commonly performed procedures that have a significant number of female patients.

Method A retrospective cohort of patients from 2011 to 2020 who underwent isolated coronary artery bypass graft (CABG) and aortic valve surgery was studied. To compare the surgical quality of men and women, a 1:1 propensity score matching (two groups of 680 patients operated by men and women, respectively, factors: age, logarithm of EuroSCORE (ES), elective, urgent or emergent surgery, isolated aortic valve, or isolated CABG) was performed. Procedure time, bypass time, x-clamp time, hospital stay, and early mortality were compared.

Results After propensity score matching between surgeons of both sexes, patients operated by males (PoM) did not differ from patients operated by females (PoF) in mean age (PoM: 66.72 ± 9.33, PoF: 67.24 ± 9.19 years, p = 0.346), log. ES (PoM: 5.58 ± 7.35, PoF: 5.53 ± 7.26, p = 0.507), or urgency of operation (PoM: 43.09% elective, 48.97% urgent, 7.94% emergency, PoF: 40.88% elective, 55.29% urgent, 3.83% emergency, p = 0.556). This was also the case for male and female patients separately. Female surgeons had higher procedure time (PoM: 224.35 ± 110.54 min; PoF: 265.41 ± 53.60 min), bypass time (PoM: 107.46 ± 45.09 min, PoF: 122.42 ± 36.18 min), and x-clamp time (PoM: 61.45 ± 24.77 min; PoF: 72.76 ± 24.43 min). Hospitalization time (PoM: 15.96 ± 8.12, PoF: 15.98 ± 6.91 days, p = 0,172) as well as early mortality (PoM: 2.21%, PoF: 3.09%, p = 0.328) did not differ significantly. This was also the case for male and female patients separately.

Conclusion Our study reveals that in routine heart surgery, the gender of the surgeon does not impact the success of the operation or the early outcome of patients. Despite taking more time to perform procedures, female surgeons demonstrated comparable surgical outcomes to their male counterparts. It is possible that women's inclination for thoroughness contributes to the longer duration of procedures, while male surgeons may prioritize efficiency. Nevertheless, this difference in duration did not translate into significant differences in primary outcomes following routine cardiac surgery. These findings highlight the importance of recognizing the equal competence of female surgeons and dispelling biases regarding their surgical performance.

Keywords

gender - sex - cardiac surgery - outcome

Authors' Contribution

F.S. carried out the statistical work on the manuscript as well as the very elaborate additional statistical evaluation of the revision, in which we responded to the reviewer's suggestion to statistically analyze the influence of each surgeon's degree of experience and to include it in the overall consideration. Given the relevance of this additional work, we believe that F.S. has made an equal contribution to this work.




Publication History

Received: 09 December 2022

Accepted: 06 November 2023

Article published online:
10 May 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Rieder A, Lhoff B. Einleitung. In: Rieder, Anita, Lhoff, Birgitte (Hrsg.): Gender Medizin. Geschlechtsspezifische Aspekte für die klinische Praxis. Springer-Verlag, Wien: 2004: 1-9
    Search in Google Scholar
  • 2 Slomski A. Female patients fare worse with male surgeons. JAMA 2022; 327 (05) 416
    Search in Google Scholar
  • 3 Xepoleas MD, Munabi NCO, Auslander A, Magee WP, Yao CA. The experiences of female surgeons around the world: a scoping review. Hum Resour Health 2020; 18 (01) 80
    Search in Google Scholar
  • 4 Kass RB, Souba WW, Thorndyke LE. Challenges confronting female surgical leaders: overcoming the barriers. J Surg Res 2006; 132 (02) 179-187
    Search in Google Scholar
  • 5 Ash AS, Carr PL, Goldstein R, Friedman RH. Compensation and advancement of women in academic medicine: is there equity?. Ann Intern Med 2004; 141 (03) 205-212
    Search in Google Scholar
  • 6 Elston MA. Women and Medicine. The Future. London:: Royal College of Physicians,; 2009
    Search in Google Scholar
  • 7 Shemanski KA, Ding L, Kim AW. et al. Gender representation among leadership at national and regional cardiothoracic surgery organizational annual meetings. J Thorac Cardiovasc Surg 2021; 161 (03) 733-744
    Search in Google Scholar
  • 8 Accessed December 9, 2022 at: https://www.dgthg.de/de/kliniken_herzzentren
  • 9 Accessed December 9, 2022 at: https://www.sana.de/herzchirurgie-stuttgart/gut-zu-wissen/presse/kinderherzen-in-besten-haenden-neue-chefaerztin-fuer-die-kinderherzchirurgie
  • 10 Ceppa DP, Antonoff MB, Tong BC. et al. 2020 women in thoracic surgery update on the status of women in cardiothoracic surgery. Ann Thorac Surg 2022; 113 (03) 918-925
    Search in Google Scholar
  • 11 Ceppa DP, Dolejs SC, Boden N. et al. Gender bias and its negative impact on cardiothoracic surgery. Ann Thorac Surg 2020; 109 (01) 14-17
    Search in Google Scholar
  • 12 Wallis CJ, Ravi B, Coburn N, Nam RK, Detsky AS, Satkunasivam R. Comparison of postoperative outcomes among patients treated by male and female surgeons: a population based matched cohort study. BMJ 2017; 359: j4366
    Search in Google Scholar
  • 13 Ho DE, Imai K, King G, Stuart EA. MatchIt: nonparametric preprocessing for parametric causal inference. J Stat Softw 2011; 42 (08) 1-28
    Search in Google Scholar
  • 14 R Core Team ( 2021 R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. Accessed March 27, 2024 at: https://www.R-project.org/
    Search in Google Scholar
  • 15 Bates D, Maechler M, Ben Bolker SW. Fitting linear mixed-effects models using lme4. J Stat Softw 2015; 67 (01) 1-48
    Search in Google Scholar
  • 16 Dixon LK, Dimagli A, Di Tommaso E. et al. Females have an increased risk of short-term mortality after cardiac surgery compared to males: insights from a national database. J Card Surg 2022; 37 (11) 3507-3519
    Search in Google Scholar
  • 17 Sutton PA, Mason J, Vimalachandran D, McNally S. Attitudes, motivators, and barriers to a career in surgery: a national study of U.K. undergraduate medical students. J Surg Educ 2014; 71 (05) 662-667
    Search in Google Scholar
  • 18 Wirtzfeld DA. The history of women in surgery. Can J Surg 2009; 52 (04) 317-320
    Search in Google Scholar