Differences in Postoperative Outcomes After Carotid Endarterectomies Performed by Female versus Male Surgeons
Stefan Ionac1, Hagen Kerndl2, Tobias Dominik Warm2
1Vascular Surgery, Faculty of Medicine, University of Augsburg, Augsburg, Germany; CerVasc, Vascular and Endovascular Surgery Research Center, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania; Manchester Academic Vascular Research and Innovation Centre (MAVRIC), Manchester University NHS Foundation Trust, Manchester, UK.
Background:
To evaluate whether the sex of the operating surgeon influences postoperative outcomes after carotid endarterectomy (CEA). We hypothesized that patients treated by female surgeons have lower complication rates or mortality.
Methods:
A retrospective, single-center analysis was conducted of all CEA procedures performed between January 2012 and December 2023 by the Clinic of Vascular Surgery of the University Hospital Augsburg. Patient demographics, comorbidities, and operative details were collected from the German national quality assurance database. The primary outcomes included perioperative complications and 30-day mortality. Secondary outcomes included operative time and surgical technique preference. Outcomes were compared between cases performed by male and female surgeons using univariate analysis and multivariable logistic regression.
Results:
A total of 1130 CEA operations met the inclusion criteria. Of these, 905 (80.1%) were performed by male surgeons and 225 (19.9%) by female surgeons. Patient characteristics were comparable between the two groups. Male surgeons more frequently used eversion endarterectomy (odds ratio for eversion by male vs. female surgeon 1.65; 95% confidence interval: 1.02-2.67; P = 0.04). The median incision-to-suture operative time was longer under female surgeons (101 min [interquartile range: 87-118] vs. 86 [70-106] min for male surgeons; P < 0.001). The rate of any perioperative complication was 4.4% for female surgeons versus 6.6% for male surgeons (P = 0.32). Thirty-day mortality was low in both groups (0.4% vs. 0.7%; P = 0.67).
Conclusion:
Surgeon sex was not associated with significant differences in perioperative complications or mortality following CEA. Female surgeons had significantly longer operative times, without negatively impacting patient outcomes. These findings support sex equity in vascular surgery.
