The sex of the surgeon performing total hip arthroplasty (THA) has no impact on postoperative adverse events, according to a study from Sweden, which adds to the literature refuting sex stereotyping in orthopaedic surgery.
The researchers found that the rate of adverse events is essentially the same for THAs performed by female and male orthopaedic surgeons..
The study, published online ahead of print by The Journal of Bone & Joint Surgery, focused on rates of adverse events requiring unexpected rehospitalization within 90 days, including surgical complications such as dislocations or wound infections and medical complications such as myocardial infarction or stroke. Adverse event rates were compared for female versus male orthopaedic surgeons, with adjustment for differences between surgeon and patient characteristics.
Study Methods and Findings
This retrospective study focused on patients who underwent primary THA between 2008 and 2016 at 10 hospitals in western Sweden. Data were extracted from the Swedish Hip Arthroplasty Register (SHAR) and a regional patient register and included:
- Surgeon-related information: Sex, annual volume, level of training
- Patient-related information: Sex, age, Elixhauser comorbidity index
The 11,993 primary THAs in the registry had been performed by 200 surgeons. Sweden has one of the highest rates of female orthopaedic surgeons worldwide, and women accounted for 17.5% of the surgeons included in the study (14% of the attending physicians and 34% of the residents).
Compared with the men in the study, the women:
- Were younger
- Were at earlier stages in their careers
- Performed a slightly lower volume of THA procedures: 19 per year versus 23 for men on average
The overall rate of adverse events at 90 days after THA was lower for procedures performed by female surgeons (attendings and residents combined) than for male surgeons: 6% versus 7%, respectively. When adjusted for patient age, sex, and health and surgeon annual volume, no association was seen between adverse events and sex of the surgeon. The same was true of a sensitivity analysis comparing adverse event rates for attending surgeons only.
Orthopaedic surgery has a long way to go to overcome existing gender disparities. The researchers cite statistics showing that only 11% of US women in orthopaedic surgery specialize in hip and knee arthroplasty.
“Stereotypes of orthopaedic surgeons within each subspecialty including fields such as arthroplasty, which is perceived to be more physically demanding, may result in fewer women selecting certain orthopaedic subspecialties,” the researchers said. For these and other reasons, women graduating from medical school may be dissuaded from choosing or considering specialty training in orthopaedic surgery.
The findings support a recent US study that found no difference in complication rates following total hip and knee replacement surgery between male and female surgeons.  The authors hope their study will help to overcome persistent stereotypes about the capabilities and outcomes achieved by female surgeons – and contribute to the literature addressing the ongoing sex disparity in orthopaedic surgery.
Jolbäck P, Rogmark C, De Mattos CBR, Chen AF, Nauclér E, Tsikandylakis G. The influence of surgeon sex on adverse events following primary total hip arthroplasty: a register-based study of 11,993 procedures and 200 surgeons in Swedish public hospitals. J Bone Joint Surg Am. 2022 May 24. doi: 10.2106/JBJS.21.00744. Online ahead of print.
- Chapman TR, Zmistowski B, Votta K, Abdeen A, Purtill JJ, Chen AF. Patient complications after total joint arthroplasty: does surgeon gender matter? J Am Acad Orthop Surg. 2020 Nov 15;28(22):937-944. doi: 10.5435/JAAOS-D-19-00740.