Sex, race and surgery: are post-operative death rates affected by gender and ethnicity?

Posted: 30/06/2022

When considering the potential risks of undergoing surgery, we are unlikely to take into account our gender, or our surgeon’s gender. However, a recent study has suggested that female patients were 32% more likely to die when operated on by a male surgeon in comparison to a female surgeon. The outcomes of male patients were not affected by the gender of the surgeon.

The research, titled ‘Association of Surgeon-Patient Sex Concordance With Postoperative Outcomes’, looked at 1.3 million patients and nearly 3,000 surgeons. The study included a variety of types of procedures, including appendix removals, heart bypasses and brain surgery. The researchers assert that this publication is the first to consider the gender of patients and surgeons in relation to patient outcomes.

The researchers reviewed a range of negative outcomes, including death, readmission to hospital, and any complications arising within 30 days of the surgery. When looking at all ‘adverse post-operative outcomes’ grouped together, women were 15% more likely to suffer an adverse outcome when operated on by a male surgeon (again compared to male patients, who had no difference in outcome due to surgeon gender).

Breaking this down further, women were at a 16% greater risk for complications with a male surgeon, as well 11% more likely to need readmission to hospital, and 20% more likely to need a longer hospital stay.

The research paints a concerning picture and raises questions as to why this discrepancy in outcomes may be occurring. Hopefully, the attention this research has attracted will help spread awareness and therefore increase the likelihood of investigations and the introduction of corrective measures.

In relation to Black and minority ethnic (BAME) patients, there appear to be few widely known or large-scale studies investigating whether any similar imbalances can be seen.

A study of just under 36,000 adult patients found that ethnicity did not affect the outcome in emergency abdominal surgeries between 2008 and 2012. In contrast, a study of 7,106 patients in North America found that ‘Black race and Hispanic ethnicity are independently associated with mortality in children who require cardiac extracorporeal life support.’ However, these studies had more defined parameters and therefore do not fully address the potential imbalances BAME communities could be facing on a wider scale.

A press release from the Government Equalities Unit in 2020 discussed the finding that, despite outcomes for mothers and babies improving overall since 2010, Black British mothers are alarmingly five times more likely to die in pregnancy, or during the six weeks after childbirth, when compared to white women. Further, women of mixed ethnicity are stated to be three times more at risk, and Asian women bear almost twice the risk. Please see our recent article about the steps being taken to try to improve here.

In addition, wider commentary is increasingly sceptical that the only reason for differing outcomes for Covid patients from ethnic minority backgrounds is purely due to genetic differences in immunity to the virus. We may see more evidence of imbalances in this context as we accumulate more knowledge of the virus and retrospective data of outcomes.

While the standard of surgical care in the UK is generally good and the risks of post-operative complications are relatively low, it is concerning that these discrepancies in outcome arise in relation to gender and ethnicity. We are hopeful that the increasing awareness and frequency of these discussions will lead to further research in this area. For now, it is clear that more investigation needs to be done to ensure that, regardless of our gender, our surgeon’s gender or our ethnicity, we are all provided with the same quality of care.

This article was co-written with Lara Wylder, trainee solicitor in the personal injury and clinical negligence team. 

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