美国加州大学洛杉矶分校大卫·格芬医学院Yusuke Tsugawa团队研究了患者-外科医生的性别一致性与患者术后死亡率的相关性。该研究于2023年11月22日发表在《英国医学杂志》上。

为了确定在美国，患者-外科医生的性别一致性是否与患者术后死亡率相关，研究组在美国的急诊医院进行了一项回顾性观察研究。2016-2019年，招募65-99岁的服务受益人接受了14项重大择期或非择期（紧急或非常紧急）手术之一，享受100%的医疗保险费用。主要结局为术后死亡率，定义为手术后30天内死亡。根据患者和外科医生的特点以及医院的固定效果进行了校正（有效地比较了同一医院内的患者）。

在2902756名接受手术的患者中，1287845名（44.4%）由同性外科医生进行手术（1201712名（41.4%）男患者和男外科医生，86133名（3.0%）女患者和女外科医生），1614911名（55.6%）由不同性别的外科医生进行手术。男性患者-男性外科医生组手术后30天的校正死亡率为2.0%、男性患者-女性外科医生组为1.7%，女性患者-男性外科医生组为1.5%，女性患者-女性外科医生组为1.3%。

患者-外科医生的性别一致性与女性患者的死亡率略低有关（校正后的风险差异-0.2个百分点；P＜0.001），但男性患者的死亡率较高（0.3；P＜0.001），尽管差异很小且没有临床意义。没有证据表明非择期手术的手术死亡率因患者和外科医生的性别一致性而不同。

研究结果表明，四种类型的患者-外科医生性别组的术后死亡率相似（即差异很小，没有临床意义）。

附：英文原文

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

Author: Christopher JD Wallis, Angela Jerath, Ryo Ikesu, Raj Satkunasivam, Justin B Dimick, E John Orav, Melinda Maggard-Gibbons, Ruixin Li, Arghavan Salles, Zachary Klaassen, Natalie Coburn, Barbara L Bass, Allan S Detsky, Yusuke Tsugawa

Issue&Volume: 2023/11/22

Abstract:

Objective To determine whether patient-surgeon gender concordance is associated with mortality of patients after surgery in the United States.

Design Retrospective observational study.

Setting Acute care hospitals in the US.

Participants 100% of Medicare fee-for-service beneficiaries aged 65-99 years who had one of 14 major elective or non-elective (emergent or urgent) surgeries in 2016-19.

Main outcome measures Mortality after surgery, defined as death within 30 days of the operation. Adjustments were made for patient and surgeon characteristics and hospital fixed effects (effectively comparing patients within the same hospital).

Results Among 2902756 patients who had surgery, 1287845 (44.4%) had operations done by surgeons of the same gender (1201712 (41.4%) male patient and male surgeon, 86133 (3.0%) female patient and female surgeon) and 1614911 (55.6%) were by surgeons of different gender (52944 (1.8%) male patient and female surgeon, 1561967 (53.8%) female patient and male surgeon). Adjusted 30 day mortality after surgery was 2.0% for male patient-male surgeon dyads, 1.7% for male patient-female surgeon dyads, 1.5% for female patient-male surgeon dyads, and 1.3% for female patient-female surgeon dyads. Patient-surgeon gender concordance was associated with a slightly lower mortality for female patients (adjusted risk difference 0.2 percentage point (95% confidence interval 0.3 to 0.1); P<0.001), but a higher mortality for male patients (0.3 (0.2 to 0.5); P<0.001) for elective procedures, although the difference was small and not clinically meaningful. No evidence suggests that operative mortality differed by patient-surgeon gender concordance for non-elective procedures.

Conclusions Post-operative mortality rates were similar (ie, the difference was small and not clinically meaningful) among the four types of patient-surgeon gender dyads.

DOI: 10.1136/bmj-2023-075484

Source: https://www.bmj.com/content/383/bmj-2023-075484