Gender Affects Operative Volume and Autonomy for Vascular Surgery Trainees in Australia and Aotearoa New Zealand

Operative logbooks are frequently used as a surrogate marker for surgical autonomy and technical competency. The primary objective of this study is to analyze differences in open and endovascular arterial surgery exposure and independence according to trainee gender using Vascular Surgery trainee operative logbooks.

Cross-sectional quantitative analysis of endovascular and open arterial procedures (carotid, lower limb, and aortic) recorded in operative logbooks between 2015 and 2022 for all Australian and New Zealand Vascular Surgery trainees was performed.

Centralized, bi-national vascular surgery training program in Australia and New Zealand PARTICIPANTS: Logbook data from 99 trainees (77 men, 22 women) were analyzed, amounting to 312 training years.

Overall, men did significantly more open cases per year compared with women (median 190 vs. 159.5, p < 0.001), and were more likely to be primary surgeon (median 142 vs. 117, p < 0.001). There was no significant gender difference in overall volume of endovascular cases per year (median 140 vs. 139, p = 0.24) or as primary surgeon (median 108 vs. 93.5, p = 0.10). Compared to men, women trainees performed less procedural volume overall and less as primary surgeon, for both open and endovascular aortic surgery. The volume of carotid and peripheral surgery was less for women than men, but there were no statistically significant gender differences in being primary surgeon for these procedures. Across all major arterial cases, the likelihood of a trainee being primary surgeon progressively increased with year of training (5th Year versus 1st Year, aOR 7.34, 95% CI 6.37-8.45, p < 0.001) but was unchanged by trainee gender.

Women in vascular surgery training performed lower volumes of aortic and carotid surgery than men, with less opportunities to be primary surgeon. These findings likely reflect a combination of entrustment bias, limited mentorship, and differences in learning environments rather than trainee preference or capability.