Patients have better outcomes in hospitals with higher ratio of female surgical teams

Care in hospitals with greater than 35 per cent female anesthesiologist and surgeon teams was associated with a three per cent reduction in the odds of postoperative complications in the three months following surgery, according to a study from ICES, Sunnybrook Research Institute and the University of Toronto.

This is one of the first studies to focus on sex diversity of operating room teams, building on past work that has compared the impact of individual surgeon and anesthesiologist characteristics on patient outcomes.

“We wanted to challenge the binary approach of comparing female and male clinicians and rather highlight the importance of diversity as a team asset or bonus in enhancing quality care,” says lead author Julie Hallet, a scientist with ICES and Sunnybrook Research Institute, and associate professor of surgery at U of T’s Temerty Faculty of Medicine.

Published in the British Journal of Surgery, the study includes population-based, health-care data on 709,899 adult patients undergoing major inpatient surgeries in Ontario, Canada between 2009 and 2019.

Sex diversity of surgical teams was defined as the percentage of female anesthesiologists and surgeons among all anesthesiologists and surgeons working in the hospital each year. The primary outcome was 90-day major morbidity, which the researchers analyzed with a standardized classification scale to identify severe post-surgical complications.

The findings showed that reaching a critical mass of more than 35 per cent female anesthesiologists and surgeons was linked to lower odds of severe complications. The association between greater sex diversity and reduced post-surgical complications was even greater for patients treated by female anesthesiologists and female surgeons, which aligns with previous studies comparing outcomes of male to female surgeons.

“These results are the start of an important shift in understanding the way in which diversity contributes to better quality care around the time of surgery,” says Hallet. “Ensuring a critical mass of female anesthesiologists and surgeons in operative teams is crucial to performance. Below a critical mass, female clinicians may withhold their perspectives, such that the benefits of diversity can only be achieved once minimum representation is reached.”

One limitation of the study is that the data did not include gender as a social construct. It is possible that gender roles, behaviours, and attitudes would have influenced the strength of the association. The researchers said further research is also needed to explore diversity based on other sociodemographic variables, including but not limited to, race and ethnicity.

Nevertheless, this study is the first to show a robust association between team sex diversity, better patient outcomes, and higher quality care.

“We hope that these results will encourage hospitals to intentionally foster sex diversity in operating room teams to reduce poor health outcomes, which, in turn, can improve patient satisfaction and promote sustainability of health systems,” says Gianni Lorello, staff anesthesiologist at Toronto Western Hospital, University Health Network, and an associate professor with Temerty Medicine’s department of anesthesiology and pain medicine.

“Ensuring sex-diversity in operative teams will require intentional effort for recruitment and retainment policies for female physicians, structural interventions such as minimum representation on teams, and monitoring and reporting of teams’ composition to build institutional accountability in existing systems,” adds Lorello.
 
This research was supported by the Sunnybrook Alternate Funding Plan Innovation Fund.