May 26, 2022 – Rates of adverse events after hip replacement surgery are essentially the same for procedures performed by female and male orthopaedic surgeons, concludes a Swedish study in The Journal of Bone & Joint Surgery. The journal is published in the Lippincott portfolio in partnership with Wolters Kluwer.
In fact, the adverse event rate after total hip arthroplasty (THA) is slightly lower for female surgeons, according to the new research by Per Jolbäck, RN, PhD, of University of Gothenburg and colleagues. They write, “This observed difference in adverse events between female and male surgeons was small and likely lacks clinical relevance.”
Findings help refute sex stereotypes in orthopaedic surgery
The researchers used Swedish registry data to analyze the effects of surgeon sex on the outcomes of THA. The analysis included data on 11,993 primary THA procedures performed by 200 surgeons, 35 of whom were women. Sweden has one of the highest rates of female orthopaedic surgeons worldwide.
The study 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.
Female orthopaedic surgeons were younger and tended be at earlier stages in their careers. In the study, women accounted for 14% of attending physicians and 34% of residents. Female surgeons performed a slightly lower volume of THA procedures, with an average of 19 THAs per year compared to 23 for male surgeons.
The overall rate of adverse events was lower for THA procedures performed by female surgeons (both attending surgeon and residents included): 6%, compared to 7% for male surgeons. On analysis for factors including patient age, sex, and health and surgeon annual volume of THA procedures, there was a “marginal” difference in adverse events between female and male orthopaedic surgeons. The same was true when comparing adverse event rates for only female and male attending surgeons.
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 orthopedic surgery are hip and knee arthroplasty specialists. One
“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,” Dr. Jolbäck and colleagues write. 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 persisting stereotypes about the capabilities and outcomes achieved by female surgeons – and contribute to the literature addressing the ongoing sex disparity in orthopaedic surgery.
DOI: 10.2106/JBJS.21.00744