Association of surgeon-patient sex concordance with postoperative outcomes following complex cancer surgery

J Surg Oncol. 2024 Mar;129(3):489-498. doi: 10.1002/jso.27527. Epub 2023 Nov 22.


Background and objectives: Sex concordance may impact the therapeutic relationship and provider-patient interactions. We sought to define the association of surgeon-patient sex concordance on postoperative patient outcomes following complex cancer surgery.

Methods: Patients who underwent surgery for lung, breast, hepato-pancreato-biliary, or colorectal cancer between 2014 and 2020 were identified from the Medicare Standard Analytic Files. The impact of surgeon-patient sex concordance or discordance on achieving an optimal postoperative textbook outcome (TO) was assessed using multivariable logistic regression.

Results: Among 495 628 patients, 241 938 (48.8%) patients were sex concordant with their surgeon while 253 690 (51.2%) patients were sex discordant. Sex discordance between surgeon and patient was associated with a decreased likelihood to achieve a postoperative TO (odds ratio [OR]: 0.95, 95% CI: 0.93-0.97; p < 0.001). Sex discordance was associated with a higher risk of complications (OR: 1.05, 95% CI: 1.03-1.07; p < 0.001) and 90-day mortality (OR: 1.05, 95% CI: 1.01-1.09; p = 0.011). Of note, male patients treated by female surgeons (OR: 0.96, 95% CI: 0.93-0.99; p = 0.017) had a similar lower likelihood to achieve a TO as female patients treated by male surgeons (OR: 0.90, 95% CI: 0.86-0.93; p < 0.001).

Conclusions: Sex discordance was associated with a reduced likelihood of achieving an "optimal" postoperative course following complex cancer surgery.

Keywords: cancer surgeries; postoperative outcomes; sex concordance; sex discordance; textbook outcomes.

MeSH terms

  • Aged
  • Female
  • Humans
  • Male
  • Medicare
  • Neoplasms* / complications
  • Neoplasms* / surgery
  • Postoperative Complications / etiology
  • Surgeons*
  • United States / epidemiology