SAN FRANCISCO — Fifteen years of data from two large medical centers showed that anesthesiologists’ technical performance was better when the provider was a woman, although the difference didn’t translate to improved post-operative complication rates, a researcher said here.
Intraoperative rates of hypoxemia, hypotension, and hyper- or hypocapnia were all lower with female versus male anesthesiology providers, according to Dario von Wedel, a student at Harvard Medical School in Boston, presumably indicating closer attention to the patients’ condition.
Overall, odds of intraoperative complications were lower by 5% when the provider was female (adjusted OR 0.95, 95% CI 0.93-0.96) in the study of more than 600,000 procedures, von Wedel said at the American Society of Anesthesiologists annual meeting.
Rates of major post-operative complications including cardiovascular, renal, or pulmonary events; hospital readmission; or death, however, were the same between provider sexes (aOR 0.99, 95% CI 0.98-1.01).
On the other hand, the gender gap became a divide when the data were stratified according to providers’ career status. Intraoperative complication rates were slightly higher for female versus male trainees (aOR 1.03, 95% CI 1.01-1.06). For more advanced professionals (attendings and certified nurse anesthetists), however, women held a substantial advantage over their male counterparts (aOR 0.84, 95% 0.83-0.86).
The results don’t quite match those seen previously for surgeons’ performance: a now-famous 2017 study found significantly improved survival for patients treated by female versus male surgeons. Indeed, it was those findings that prompted the current study, from which von Wedel and colleagues hypothesized that something similar would be found for anesthesiologists.
They examined records for procedures done with anesthesia at Beth Israel Deaconess Medical Center in Boston and at Montefiore Medical Center in the Bronx, New York, from 2008-2022, with a total of 602,408. About 40% of all procedures were performed primarily by trainees. Some 43% of providers were women, and they were busier than their male colleagues, serving in 51% of cases. Data were adjusted for patient and procedural factors such as surgical complexity, patients’ body mass index, emergency status, and type of anesthesia care (general anesthesia was given in around 60% of cases; the others involved monitored or regional anesthesia).
With no difference by sex in post-operative complication risk, the findings only supported half of the researchers’ initial hypothesis. And while one might expect that the relatively large gender gap seen for non-trainee providers would translate to a difference in post-operative complications, the researchers didn’t perform that subgroup analysis.
Still, a lively audience discussion followed von Wedel’s presentation. Several comments alluded to what might be called the “Ginger Rogers effect” (referring to the dancer’s probably apocryphal remark that she did all the same moves as Fred Astaire, but “backwards and in high heels”). As one member put it, “females are more concerned about how they are judged” in the workplace, and thus follow established procedures more closely.
Session co-moderator Davide Cattano, MD, of UTHealth Houston in Texas, agreed, noting that female anesthesiologists may be “more attentive to early indicators of complications.” Cattano also suggested that the study’s long timeline, spanning procedures performed up to 15 years ago, might have affected the results, in light of the increasing prevalence of women in medicine (including anesthesiology).
Another audience member commented that anesthesiologists don’t work alone, but in concert with the surgeon and other professionals in the room; whether the surgeon is a man or women may make a difference depending on the anesthesiologist’s sex.
Von Wedel agreed that this was something to consider, and said his group intends to pursue the issue by looking “at the whole team.”
One potential limitation to the study was that the proportion of female anesthesia providers at the two centers was considerably greater than the national average, which a recent report put at 26%, thus the results may not be broadly generalizable.
No commercial funding for the study was reported, and von Wedel declared he had no relevant financial interests.
American Society of Anesthesiologists
Source Reference: von Wedel D, et al “The association of anesthesia provider sex with perioperative complications: a multicenter retrospective cohort study” ASA 2023; Abstract A1217.