日本东京大学Sachiyo Nomura团队比较了日本男性和女性胃肠外科医生的短期手术结局。该研究于2022年9月28日发表在《英国医学杂志》上。

为了比较日本男性和女性胃肠外科医生的短期手术结局，研究组依据日本国家临床数据库（包括日本95%以上的手术数据）（2013-17年）和日本胃肠外科学会的数据，参与者为进行远端胃切除术、全胃切除术和低位前切除术的男性和女性外科医生。

主要结局为手术死亡率、手术死亡合并术后并发症、胰瘘（仅远端胃切除术/全胃切除术）和吻合口瘘（仅低位前切除术）。采用经患者、外科医生和医院特征校正的多变量逻辑回归模型，研究外科医生性别与手术相关死亡率和手术并发症的关系。

共有149193例远端胃切除术（男性外科医生：140971人[94.5%]；女性外科医生：8222人[5.5%]）；63417例全胃切除术（男性外科医生：59915人[94.5%]； 女性外科医生：3502人[5.5%]）；和81593例低位前切除手术（男性外科医生：77864人[95.4%] ；女性外科医生：3729人[4.6%]）。

平均而言，女性外科医生注册后的时间更短，手术风险更高，腹腔镜手术次数也少于男性外科医生。男性和女性外科医生的手术死亡校正风险（远端胃切除术的校正优势比为0.98；全胃切除术为0.83；低位前切除术为0.56），手术死亡与Clavien Dindo分级≥3例并发症（远端胃切除术的校正优势比为1.03；全胃切除术为0.92；低位前切除术为1.02），胰瘘（远端胃切除术校正优势比为1.16；全胃切除术为1.02），吻合口瘘（低位前切除术校正优势比为1.04）的校正风险均无显著差异。

这项研究发现，男性与女性胃肠外科医生的手术结局没有显著的校正后风险差异。尽管不完美，女性外科医生还是会接诊高危患者。在日本，女性医生可以获得更多的外科培训。

附：英文原文

Title: Comparison of short term surgical outcomes of male and female gastrointestinal surgeons in Japan: retrospective cohort study

Author: Kae Okoshi, Hideki Endo, Sachiyo Nomura, Emiko Kono, Yusuke Fujita, Itaru Yasufuku, Koya Hida, Hiroyuki Yamamoto, Hiroaki Miyata, Kazuhiro Yoshida, Yoshihiro Kakeji, Yuko Kitagawa

Issue&Volume: 2022/09/28

Abstract:

Objective To compare short term surgical outcomes between male and female gastrointestinal surgeons in Japan.

Design Retrospective cohort study.

Setting Data from the Japanese National Clinical Database (includes data on >95% of surgeries performed in Japan) (2013-17) and the Japanese Society of Gastroenterological Surgery.

Participants Male and female surgeons who performed distal gastrectomy, total gastrectomy, and low anterior resection.

Main outcome measures Surgical mortality, surgical mortality combined with postoperative complications, pancreatic fistula (distal gastrectomy/total gastrectomy only), and anastomotic leakage (low anterior resection only). The association of surgeons’ gender with surgery related mortality and surgical complications was examined using multivariable logistic regression models adjusted for patient, surgeon, and hospital characteristics.

Results A total of 149193 distal gastrectomy surgeries (male surgeons: 140971 (94.5%); female surgeons: 8222 (5.5%)); 63417 gastrectomy surgeries (male surgeons: 59915 (94.5%); female surgeons: 3502 (5.5%)); and 81593 low anterior resection procedures (male surgeons: 77864 (95.4%);female surgeons: 3729 (4.6%)) were done. On average, female surgeons had fewer post-registration years, operated on patients at higher risk, and did fewer laparoscopic surgeries than male surgeons. No significant difference was found between male and female surgeons in the adjusted risk for surgical mortality (adjusted odds ratio 0.98 (95% confidence interval 0.74 to 1.29) for distal gastrectomy; 0.83 (0.57 to 1.19) for total gastrectomy; 0.56 (0.30 to 1.05) for low anterior resection), surgical mortality combined with Clavien-Dindo grade ≥3 complications (adjusted odds ratio 1.03 (0.93 to 1.14) for distal gastrectomy; 0.92 (0.81 to 1.05) for total gastrectomy; 1.02 (0.91 to 1.15) for low anterior resection), pancreatic fistula (adjusted odds ratio 1.16 (0.97 to 1.38) for distal gastrectomy; 1.02 (0.84 to 1.23) for total gastrectomy), and anastomotic leakage (adjusted odds ratio 1.04 (0.92 to 1.18) for low anterior resection).

Conclusion This study found no significant adjusted risk difference in the outcomes of surgeries performed by male versus female gastrointestinal surgeons. Despite disadvantages, female surgeons take on patients at high risk. Greater access to surgical training for female physicians is warranted in Japan.

DOI: 10.1136/bmj-2022-070568

Source: https://www.bmj.com/content/378/bmj-2022-070568